Mucormycosis is a rare and life-threatening fungal infection that is associated with high mortality in immunocompromised individuals. Although it most commonly affects lungs and paranasal sinuses, cases of invasive mucormycosis of the gastrointestinal tract have also been reported. Gastrointestinal mucormycosis (GIM) is most commonly found in the stomach, colon, and ileum. Etiologies of GIM include ingestion of spores and penetrating abdominal trauma, causing mucocutaneous disruption. We present a case of an immunocompetent man who presented to our hospital after a gunshot wound to the abdomen. His hospital course was complicated with the development of invasive GIM in the form of a large gastric ulcer, which caused gastrointestinal bleeding and eventually perforation.
172 Background: Gastric cancer (GC) remains a pervasive condition in the US with high morbidity and mortality. Race/ethnicity, lack of insurance, and poverty may all be contributing to this burden, especially in select populations. We evaluated the impact of these sociodemographic factors on GC outcomes at a hospital with high immigrant-patient populations. Methods: We conducted a retrospective study to identify patients diagnosed with GC between year 2010 and 2019. Data obtained from our institution database regarding patients' sociodemographic factors, including age, gender, race/ethnicity, insurance status and type, and neighborhood socioeconomic status. Likewise, information on tumor histology, anatomic location, and stage were also obtained. Kaplan-Meier analysis was used to plot survival curves and analyze the impact of insurance on survival outcome. Results: One hundred eleven patients were analyzed in this study, with a male-to-female ratio of 1.26:1. The median age at the time of GC diagnosis was 52.9 (range 27-87) years, with median survival time (±SD, range) of 12.7 (±17.7, 0.25-84) months. Most patients (69.4%) were uninsured—out of which 76.7% presented with advanced-stage disease. Among those, the majority (70.3%) were Hispanic, and 60.4% were non-U.S. citizens. The most common tumor histology was diffuse-type adenocarcinoma in 55% of patients. Patients insured were on public coverage (Medicaid), private insurance, and Medicare at 11.7%, 9.9%, and 9.0%, respectively. In terms of survival, lack of insurance (p = 0.012) and Medicaid insurance (p = 0.046) were associated with the worst survival outcomes in GC patients. Conclusions: Our study reflects the trends in GC outcomes distinctly linked to significant sociodemographic disparities. Patients who lack insurance coverage had the worst survival outcomes. Therefore, efforts such as increasing healthcare access for this population-type at risk of sociodemographic incongruities may enhance outcomes and are crucial in fighting GC.
Gastrointestinal bleeding (GIB) is a common cause of hospitalization and is associated with significant morbidity and mortality. The most frequent causes of nonvariceal upper GIB are peptic ulcers, mucosal erosions, Mallory-Weiss tears, and malignancy. Current endoscopic hemostatic methods, including injections, thermal and mechanical modalities, have a 5%-10% chance of recurrent bleeding. Hemospray (Cook Medical, Winston-Salem, NC, USA) is a recently approved modality and can help treat tumor-related GIB. We present a case of a patient with diffuse large B-cell gastric lymphoma who presented with tumor-related GIB. His clinical course was complicated by gastric perforation and active bleeding which was treated with Hemospray and over-the-scope clips (OTSC, Ovesco, Tübingen, Germany).
INTRODUCTION: Gastrointestinal bleeding (GIB) is a common cause of hospitalization and is associated with significant morbidity and mortality The most frequent causes of non-variceal upper GIB are peptic ulcers, erosions, Mallory-Weiss tears and malignancy. Current endoscopic hemostatic methods; including injections, thermal and mechanical modalities, have a 5-10% chance of recurrent bleeding. Hemospray (Cook Medical, USA) is a recently approved modality and can be helpful in treating tumor-related gastrointestinal bleeding. CASE DESCRIPTION/METHODS: A 57-year-old male with advanced diffuse large B-Cell lymphoma of the stomach with a contained perforation presented to the hospital with hematemesis. On exam, the patient had epigastric tenderness and dull bowel sounds. Labs revealed Hgb of 7.2 g/dL. CT of abdomen/pelvis revealed a gastric mass in the greater curvature of the stomach with a 3.1 cm perforation (Figure 1). EGD revealed a large blood clot attached to a giant ulcer in the great curvature of the fundus (Figure 2a). No active bleeding was noted, intravenous pantoprazole was initiated. Two days later, the patient developed recurrent hemorrhage with hemodynamic instability. Blood transfusion was initiated and repeat EGD showed large gastric perforation with evidence of recent bleed. The overlying clot was removed using a snare and Hemospray was deployed achieving hemostasis of the entire ulcer (Figure 2b). Post EGD, no immediate complications were seen. CT abdomen was performed which revealed a decreased amount of intraperitoneal free air without evidence of new perforation and no active bleeding. At this point, the patient was cleared to start chemotherapy. On follow-up EGD 2 months later, the contained perforation was seen nearly resolved (Figure 3). DISCUSSION: Tumor-related gastrointestinal bleeding is a challenging problem as it is difficult to control with conventional endoscopic hemostatic techniques. Hemospray is a newly FDA approved modality that can be helpful in controlling upper, lower and tumor-related GIB. Hemospray is an inorganic compound that when in contact with blood, absorbs water and adhesively forms a barrier over the bleeding site. Hemospray, unlike traditional therapies is a nonthermal, nontraumatic, and noncontact modality that doesn’t require precise targeting of other endoscopic devices. Hemospray is not absorbed by the body and usually passes through the lower GI tract within 72 hours. Overall the spray is 95% effective to achieve hemostasis in cases with upper and lower GIB.
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