Browsing by Author "Špuran, Milan (6505943315)"

Introduction. Arteriovenous fistula of the superior mesenteric blood vessels is a rare complicaton in abdominal surgery. Case report. We presented a 49-year-old man with cramplike abdominal pain, abdominal distension and weight loss symptoms, with a history of previous small bowel resection and right colectomy, due to Crohn disease, 16 years ago. Clinical examination revealed a paraumbilical pulsation with systolic murmur and thrill. Ultrasonography and computed tomography revealed cystic dilatation of the superior mesenteric vein, hepatomegaly and ascites. Upper endoscopy revealed grade I esophageal varices with portal hypertensive gastropathy. The diagnosis of arteriovenous fistula between superior mesenteric artery and vein was confirmed by angiogram of the superior mesenteric vessels and resection of the fistula was performed. Control examination after nine months showed no signs of portal hypertension. Conclusion. Early diagnosis and treatment of mesenteric blood vessel arteriovenous fistula prevents portal hypertension development and its complications.

BACKGROUND: Endoscopic sclerotherapy is effective in securing hemostasis for bleeding lesions, but bleeding reoccurs in 10% to 30% patients (pts) and 4% to 14% pts die after upper gastrointestinal bleeding. AIM: To establish the relative importance of risk factors for rebleeding and mortality after successful endoscopic sclerotherapy of acute non-variceal upper gastrointestinal bleeding. PATIENTS AND METHODS: Prospective study included 315 pts who where admitted to hospital because of non-variceal upper gastrointestinal bleeding. All of them underwent gastroscopy with successful sclerotherapy within 12 hours after the admission to the hospital. We followed them and investigated the episode of rebleeding and death during the initial hospitalization. We included the following parameters: age, gender, drug intake, shock, bleeding stigmata, location of bleeding lesion, comorbidity and rebleeding. RESULTS AND CONCLUSION: Rebleeding occurred in 58 pts (16.8%) and was determined by shock, bleeding stigmata and comorbidity. 11 pts (3.5%) died. Shock, rebleeding and comorbidity were all independent, statistically significant predictors of patients' mortality. By analyzing bleeding patients in such a manner and defining the risk factors for rebleeding and death, clinician could easier make a decision about the future treatment of every single patient after the initial endoscopic sclerotherapy.