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Włodzimierz Nowatorski, Paweł Sobieski and Bartosz Pacewski

Gists As a Cause of Massive Bleeding

This report describes two cases of GIST with bleeding as the predominant symptom. The first case comprised a patient with a gastric carcinoma and bleeding of the digestive tract. The second patient was diagnosed with mesenteric carcinoma and peritoneal cavity bleeding. Both patients underwent emergent surgical intervention. The first patient was subjected to gastric resection, while the latter to mesentery resection. The postoperative period proved uneventful. The excised specimens were evaluated at the Department of Pathomorphology, Institute of Oncology in Warsaw. The patients were directed to the Department of Soft Tissue Neoplasms, Institute of Oncology for registration and further treatment.

Open access

Emma Fosbury, Raoul Blumber, Ri Liesner and Keith Sibson


Healthy, term neonates rarely encounter problems with bleeding, despite physiological differences in their levels of clotting factors, reflected in prolongation of the prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT). Their risk of bleeding, however, is significantly increased by the presence of a severe congenital bleeding disorder. Establishing such a diagnosis can present a particular challenge, given the rarity of these conditions and the difficulty in performing and interpreting laboratory assays in this age group. However, a delay in diagnosis and implementation of appropriate treatment can result in catastrophic sequelae. Therefore, the presentation of a healthy child at birth, whose condition rapidly deteriorates as a result of bleeding, should prompt the urgent investigation of a congenital haemostatic defect and involvement of expert haematological advice. We describe a very unusual presentation of a severe bleeding disorder in the first few days of life to highlight these issues.

Open access

Ana Maria Miulescu and Alexandru Ispas


Introduction This pathology is rare in patients younger than 40 years old (5%) and, in those older than 70 years old, almost 50% exhibit colonic diverticulosis. Most cases have mild symptoms and only 20% presents complications as: bleeding, bowel obstruction, abscess and secondary peritonitis.

Aim. The aim is to analyse different types of complications in colonic diverticulosis and compare the data from literature to those in Argeș geographical area.

Material and method. The medical records of 120 patients out of which 101 were admitted in gastroenterology department and 19 in general surgery department were analysed. Diagnosis methods: colonoscopy, computed tomography with contrast dye, simple abdominal radiograph for acute abdominal pain.

Results. 40 patients (33.33%) with asymptomatic colonic diverticulosis, 28 patients (23.33%) moderate diverticulitis, 25 patients (20.83%) with moderate anorectal bleeding, 25 patients (20.83%) with secondary peritonitis, and 2 (1.68%) cases with complications.

Conclusions. All the patients were older than 50 years old, 44 % of diverticulitis cases led to complications (almost half with bleeding and the rest with peritonitis). No bowel obstruction. In 99% of the cases, the localisation of the diverticula was at the level of sigmoid and descending colon.

Open access

Agnese Ozolina, Eva Strike and Indulis Vanags

The Predictive Value of Thrombelastography and Routine Coagulation Tests for Postoperative Blood Loss in Open Heart Surgery

Introduction. Hemorrhage after cardiopulmonary bypass remains a clinical problem.

Aim of the Study. Study was performed to compare efficacy of trombelastography (TEG) and routine coagulation tests in relation for postoperative bleeding after cardiac surgery in CPB.

Materials and methods. Forty-seven adult cardiac surgical patients were enrolled in prospective study at Pauls Stradins Clinical University Hospital in 2010. Blood samples for prothrombin time, international normalized ratio, activated partial thromboplastin time (APTT), fibrinogen level, platelet count were collected before surgery, at admission in intensive care unit (ICU) and 6, 12 hours after operation.

Before induction of general anesthesia blood sample was collected to perform kaolin activated TEG (kTEG) and at admission in ICU - kTEG and heparinase- modified kTEG.

Results. Correlation postoperatively was between kTEG reaction time (R) and APTT, as well as heparinase-modified kTEG maximum amplitude (MA) and platelet count. Significant correlation with postoperative bleeding showed heparinase-modified kTEG MA on admission to the ICU.

The highest predictive value preoperatively showed kTEG alpha angle (A), APTT, platelet count and postoperatively kTEG MA, APTT on admission to ICU.

Conclusions. Associated with bleeding are following TEG variables: preoperatively kTEG A, postoperatively kTEG MA and heparinase-modified kTEG MA. APTT and platelet count are also related to postoperative bleeding but to a lesser degree.

Open access

Anne Wareing


There is little evidence on which to define the best treatment for the prevention of bleeding in people with congenital bleeding disorders undergoing surgery. As a result, treatment regimens are frequently based on local protocols developed by expert clinicians and information from uncontrolled observational studies. This article summarises the Cochrane Cystic Fibrosis and Genetic Disorders Group systematic review on ‘Treatment for preventing bleeding in people with haemophilia or other congenital bleeding disorders (CBDs) undergoing surgery’.

Open access

Abdolhadi Jahanshahi, Esmail Mashhadizadeh and Mohammad-Hossein Sarmast

Diode Laser for Treatment of Symptomatic Hemorrhoid: A Short Term Clinical Result of a Mini Invasive Treatment, and One Year Follow Up

Hemorrhoid is protrusion of plexus or blood vessels in the anal canal. The hemorrhoid may cause symptoms that are: bleeding, pain, prolaps, itching, soilage of feces, and psychologic discomfort. There are many methods for treatment of hemorrhoid like, medical therapy, cryo-therapy, rubber band ligation, sclerotherapy, laser, and surgery. All methods have some complication in postoperative period and recurrence.

The aim of the study was to evaluate Diode laser for treatment of hemorrhoid.

Material and methods. This study included patients who suffer from the hemorrhoid. Cases with fistula and fissure had been omitted. Patients with hemorrhoid in grade 2, 3, 4 and mixed were treated with diode laser. Follow up was done 1,7,14, 30, 90, and 360 days laser therapy.

Results. In this study, 341 patients with hemorrhoid treated with diode laser were included. Results of follow-up were as follows: need for analgesia in hospital stay and home was very low total complication was seen in 12 patient (3.51%), edema in 8 patient (2.34%), hemorrhage and abscess each of them in 2 patient (0.58%), stricture and recurrence was zero after one year.

Conclusions. All methods used for hemorrhoid treatment has advantages, disadvantages, and limitations. But treatment of hemorrhoid by Diode laser, which is done by skilled surgeon has several advantages over other treatments. This advantages include, less operation time, less pain and bleeding, allow quick healing of piles, no stricture, and minimal recurrence after operation.

Open access

Agnese Ozolina, Eva Strike, Vladimirs Harlamovs and Nora Porite

Excessive Bleeding After Cardiac Surgery in Adults: Reasons and Management

Postoperative bleeding is a concern for all patients undergoing cardiac surgery. In patients exposed to cardiopulmonary bypass, bleeding following surgery is excessive in up to twelve percent of patients in whom subsequent re-exploration is required. Several studies have evaluated main reasons, prevention of excessive postoperative bleeding and impact of patients outcomes. This article contains a literature review on excessive bleeding and re-exploration following cardiac surgery, main surgical and medical sources, prevention and management of bleeding.

Open access

Xingshun Qi, Hongyu Li, Xiaodong Shao, Zhendong Liang, Xia Zhang, Ji Feng, Hao Lin and Xiaozhong Guo


Varices manifest as a major etiology of upper gastrointestinal bleeding in patients with chronic liver diseases, such as liver cirrhosis and hepatocellular carcinoma. By contrast, non-variceal upper gastrointestinal bleeding is rare. Pharmacological treatment differs between patients with variceal and non-variceal bleeding. Vasoconstrictors are recommended for the treatment of variceal bleeding, rather than non-variceal bleeding. In contrast, pump proton inhibitors are recommended for the treatment of non-variceal bleeding, rather than variceal bleeding. Herein, we present a case with liver cirrhosis and acute upper gastrointestinal bleeding who had a high risk of rebleeding (i.e., Child–Pugh class C, hepatocellular carcinoma, portal vein thrombosis, low albumin, and high international normalized ratio and D-dimer). As the source of bleeding was obscure, only terlipressin without pump proton inhibitors was initially administered. Acute bleeding episode was effectively controlled. After that, an elective endoscopic examination confirmed that the source of bleeding was attributed to peptic ulcer, rather than varices. Based on this preliminary case report, we further discussed the potential role of vasoconstrictors in a patient with cirrhosis with acute non-variceal upper gastrointestinal bleeding.

Open access

Mariusz Chabowski, Adam Paszkowski, Jerzy Skotarczak, Tadeusz Dorobisz, Michał Leśniak, Dawid Janczak and Dariusz Janczak


The study presented a case of a patient with a glomus tumor of the stomach, a mesenchymal neoplasm manifesting with upper gastrointestinal bleeding (Forrest IB). The patient was operated twice. First, he underwent elective laparotomy, during which Billroth I (Rydygier’s method) gastric resection was performed. This his was followed by Billroth II resection with Braun’s anastomosis. Histopathological examination revealed glomus tumor tissue. Literature data on the glomus tumor of the stomach are presented.

Open access

Wojciech Figiel, Michał Grąt, Karolina M. Wronka, Waldemar Patkowski, Maciej Krasnodębski, Łukasz Masior, Jan Stypułkowski, Karolina Grąt and Marek Krawczyk


Intraabdominal hemorrhage remains one of the most frequent surgical complications after liver transplantation.

The aim of the study was to evaluate risk factors for intraabdominal bleeding requiring reoperation and to assess the relevance of the reoperations with respect to short- and long-term outcomes following liver transplantation.

Material and methods. Data of 603 liver transplantations performed in the Department of General, Transplant and Liver Surgery in the period between January 2011 and September 2014 were analyzed retrospectively. Study end-points comprised: reoperation due to bleeding and death during the first 90 postoperative days and between 90 postoperative day and third post-transplant year.

Results. Reoperations for intraabdominal bleeding were performed after 45 out of 603 (7.5%) transplantations. Low pre-transplant hemoglobin was the only independent predictor of reoperation (p=0.002) with the cut-off of 11.3 g/dl. Postoperative 90-day mortality was significantly higher in patients undergoing reoperation as compared to the remaining patients (15.6% vs 5.6%, p=0.008). Post-transplant survival from 90 days to 3 years was non-significantly lower in patients after reoperation for bleeding (83.3%) as compared to the remaining patients (92.2%, p=0.096). Nevertheless, multivariable analyses did not reveal any significant negative impact of reoperations for bleeding on short-term mortality (p=0.589) and 3-year survival (p=0.079).

Conclusions. Surgical interventions due to postoperative intraabdominal hemorrhage do not appear to affect short- and long-term outcomes following liver transplantation. Preoperative hemoglobin concentration over 11.3 g/dl is associated with decreased risk of this complication, yet the clinical relevance of this phenomenon is doubtful