Abstract
Nonvariceal upper gastrointestinal bleeding is a major cause of morbidity and mortality worldwide. Despite the improvements in the treatment modalities, mortality rates have remained at 10%. Endoscopist should know the main recommendations for the management of nonvariceal upper gastrointestinal bleeding. Pre-endoscopic management is recommended for triage and optimal treatment of patients in guidelines and should consider a multidisciplinary management at an initial stage. Endoscopic therapy is an important therapeutic management of high-risk lesions and should not be delayed for more than 24 h after admission. Several endoscopic techniques have been developed and new modalities are emerging.
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Appendix: Quiz
Appendix: Quiz
A 43-year-old man presented to the emergency room after sudden-onset massive hematemesis and hematochezia. His initial vital signs revealed systolic blood pressure in the range of 60–80 mmHg. Thirteen years previously he had undergone graft and stent replacement of abdominal aortic dissection and had been diagnosed with Marfan syndrome. Emergent endoscopy revealed blood and a pulsatile mass with a central exposed vessel in the second portion of the duodenum (a, b). The patient underwent CT angiography of the abdomen, which demonstrated a 36-mm pseudoaneurysm emanating from the inferior pancreaticoduodenal artery (c). The pseudoaneurysm compressed the second portion of the duodenum. Angiography was performed and revealed active contrast leakage from the inferior pancreaticoduodenal artery (d).
What is the diagnosis (Fig. 3.40)?
Bleeding is noted in duodenal second portion (a). Bulging lesion with central vessel exposure is noted (b). Abdominal CT scan shows a pseudoaneurysm emanating from the inferior pancreaticoduodenal artery. The pseudoaneurysm compresses the second portion of the duodenum. (c). Angiography shows an active contrast leakage from the inferior pancreaticoduodenal artery (d)
Answer: Bleeding from aortoduodenal fistula.
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Yoon, J.H., Lee, H.L. (2019). Endoscopic Treatment for Nonvariceal Upper Gastrointestinal Bleeding. In: Chun, H., Yang, SK., Choi, MG. (eds) Therapeutic Gastrointestinal Endoscopy. Springer, Singapore. https://doi.org/10.1007/978-981-13-1184-0_3
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DOI: https://doi.org/10.1007/978-981-13-1184-0_3
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