Department of Pediatric Gastroenterology, NY Medical College, Westchester Medical Center, Valhalla, New York, USA (Drs Shaban, Cukaj, Sood, and Bostwick).
Department of Surgery, Division of Pediatric Surgery, NY Medical College, Westchester Medical Center, Valhalla, New York, USA (Dr Stringel).
New York Medical College, Westchester Medical Center, Valhalla, New York, USA (Dr. Helfgott).

ABSTRACT

Introduction: Vascular malformations remain a rare cause of gastrointestinal (GI) bleeding, and they can present a diagnostic challenge. The diagnostic utility of video capsule endoscopy in identifying these malformations in the pediatric population is not well documented.

Case Description: A 7-y-old male with chronic iron deficiency anemia had a clinical history of melon and occasional hematochezia of 1-year duration requiring multiple admissions to the hospital and blood transfusions. Ultrasound, Meckel scan, magnetic resonance imaging, and computed tomography (angiogram) did not demonstrate the source of bleeding. Upper and lower endoscopy studies showed no abnormalities. A video capsule endoscopy showed a lesion in the small intestine suggestive of an arteriovenous malformation. Diagnostic laparoscopy identified the vascular malformation in the mid jejunum. Laparoscopic-assisted intestinal resection including the malformation was successfully performed. After surgical resection, the anemia resolved, and the patient had no further episodes of bleeding.

Conclusions: This case illustrates the utility of video capsule endoscopy combined with laparoscopy in the management of a suspected GI arteriovenous malformation in pediatric patient.

Key Words: Anemia; Arteriovenous Malformation; Gastrointestinal Bleeding; Laparoscopy; Pediatric; Video Capsule Endoscopy.

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Department of General Surgery, Easton Hospital, Easton, PA, USA (Drs. Baccaro, Ogu, Ibrahim, and Kohli). Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA (Dr. Vunnamadala).

ABSTRACT

Introduction: Morbid obesity is an growing problem in the United States. As the incidence of morbid obesity increases, so does the number of surgical procedures for weight loss. Surgeons must learn to manage common complications of these procedures.

Case Descriptions and Operative Technique: We present two cases of massive upper gastrointestinal hemorrhage secondary to marginal ulcers eroding into the left gastric artery. A novel surgical technique has been described from these experiences to deal quickly with this highly fatal complication.

Discussion: General surgeons must be aware of the altered anatomy and physiology because they will encounter these patients in the emergency setting. It is important to be familiar with common complications, know how to identify them in a timely manner, and treat them accordingly. Marginal ulcers are frequent; however, torrential hemorrhage secondary to these is less common and extremely lethal.

Key Words: Laparoscopic Roux-en-Y gastric bypass, Marginal ulcer after gastric bypass, Gastrointestinal bleeding, Surgical technique, Emergency surgery.

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The post Massive GI Bleed from a Marginal Ulcer Eroding into the Left Gastric Artery first appeared on JSLS.