Heterotopic pancreas in Meckel’s diverticulum in an adult man with lower gastrointestinal bleeding: a case report and literature review

Chen, Shu-Rong; Zhang, Hong; Yu, Xiaofei; Chen, Yi

doi:10.21037/acr-22-105

Cited by 3 publications

(1 citation statement)

References 19 publications

(23 reference statements)

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“…Several reports of surgical resection as a curative treatment for bleeding from the ectopic pancreas are available in the literature. 1,3,4 However, the choice of endoscopic treatment has rarely been made in such cases. 5 An ectopic pancreas is typically asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of gastric ectopic pancreas with repeated ulcerations and bleeding: A case report

Kimura,

Minato,

Banjoya

et al. 2024

DEN Open

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A 25‐year‐old man was referred to our center for investigation of a gastric submucosal tumor and an ulcer that had developed on its oral side. Endoscopic ultrasonography findings suggested the presence of an ectopic pancreas, and treatment with an oral proton pump inhibitor was planned for the ulcer. Over the subsequent 3 years, the patient endured recurring epigastric pain and episodes of passing black stools. Emergency endoscopy revealed that the morphology of the gastric submucosal tumor had transformed into a pedunculated polyp‐like morphology with a bleeding ulcer at the apex of the lesion. Endoscopic hemostasis using hemostatic forceps was performed. However, the patient continued to pass black stools. In light of the persistent symptoms and unique morphology of the lesion, endoscopic resection was attempted as a curative approach. The lesion was excised by hot snare polypectomy. Post‐treatment, the patient exhibited no signs of recurrence, marking a successful resolution. Three months later, a gastroduodenal endoscopy showed that the excised site had undergone scar formation without recurrence of the lesion. This case holds significant clinical value as it demonstrates the efficacy of a minimally invasive treatment strategy in managing repeated bleeding ulcerations of an ectopic pancreas, ultimately achieving a complete cure.

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Section: Discussionmentioning

confidence: 99%

Endoscopic management of gastric ectopic pancreas with repeated ulcerations and bleeding: A case report

Kimura,

Minato,

Banjoya

et al. 2024

DEN Open

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Association Between Serum Chloride Levels and 365-Day All-Cause Mortality in Critically IV Patients with Gastrointestinal Bleeding: A Retrospective Cohort Study

You,

Zhu,

2024

Preprint

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Background: Gastrointestinal bleeding (GIB) is a significant clinical emergency with high mortality, particularly among critically ill patients. The role of serum chloride, a crucial electrolyte, in the prognosis of GIB remains unclear. This study aimed to investigate the relationship between serum chloride levels and 365-day all-cause mortality in critically ill patients with GIB. Methods: A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care (MIMIC-IV) database, including patients admitted to the intensive care unit (ICU) with a diagnosis of GIB from 2008 to 2019. Patients were stratified by serum chloride levels within the first 24 hours of ICU admission. The primary outcome was 365-day all-cause mortality. Cox regression models were used to assess the association between serum chloride and mortality, adjusting for confounders. Results: A total of 2355 patients met the inclusion criteria. Elevated serum chloride levels were associated with a lower risk of 365-day all-cause mortality in unadjusted (HR=0.95, 95% CI: 0.94-0.96) and adjusted models (HR=0.97, 95% CI: 0.95-0.99, P=0.005). Non-linearity in the association was observed, with a plateau effect at higher serum chloride levels. Subgroup analyses confirmed the consistency of this association across different patient characteristics. Conclusion: This study reveals a significant inverse association between serum chloride levels and 365-day all-cause mortality in critically ill patients with GIB. Our findings suggest that serum chloride may serve as a prognostic biomarker and could inform clinical decision-making in the management of GIB. Further research is needed to elucidate the underlying mechanisms and to validate these findings in prospective studies.

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A Rare Case of Meckel's Diverticulum Strangulation Complicated by Small Intestine Obstruction (Clinical Case)

Kravets,

Svistunov,

Moskalenko

2024

EUMJ

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Introduction. Meckel's diverticulum (MD) is a congenital anomaly of the gastrointestinal tract. In most cases, uncomplicated DM is silent. It is mainly diagnosed when complications arise or accidentally during diagnostic procedures or surgical interventions. A recognised effective diagnostic method is laparoscopy, which allows to assess the localisation and degree of pathological changes in the diverticulum. Treatment of complicated DM is surgical. The volume of surgery depends on the diameter of the diverticulum, the nature of complications, the prevalence of the inflammatory process at the base of the diverticulum and the ileum wall, and the spread of peritonitis. In this report, we would like to share our own successful experience of treating a patient with DM complicated by necrosis and volvulus of the small intestine. Case report. A 42-year-old male patient was hospitalised with complaints of abdominal pain, fever up to 38°C, and nausea. During the examination, the abdomen was distended, painful in all parts, spared during breathing. In the right iliac region and in the right lateral canal, there were weakly positive symptoms of peritoneal irritation, peristalsis was weakened. Ultrasound examination of the abdominal cavity revealed free fluid in the right hypochondrium and pelvic cavity, dilatation of the small intestine loops. Plain radiography of the abdominal cavity: pneumatosis of the intestine, small intestinal fluid levels. Video laparoscopy was performed to clarify the diagnosis under endotracheal anaesthesia. During the revision of the abdominal cavity, a defect of up to 5.0 cm in the mesentery of the small intestine with a large-sized and necrotic altered DM and a wrap around it of small intestinal loops with necrosis was detected. Resection of the necrotic loops of the small intestine with DM was performed with the application of a «side-to-side» intestinal anastomosis. The postoperative period was uneventful. The patient was discharged on day 10. Discussion. Due to the lack of characteristic symptoms, the diagnosis of DM, even in cases of complications, is sometimes established late, which entails problems in the further treatment of patients. Today, laparoscopy is the leading and most informative method in the diagnosis of DM. In some cases, it is the first stage of surgical intervention. Intestinal obstruction is one of the most common complications of DM. It is caused by small intestine torsion around a fixed diverticulum, nodule formation, and diverticulum invasion. Early diagnosis is important because delayed surgery increases mortality. We present a clinical case of complicated DM with symptoms typical of small bowel obstruction. The standard methods used at the first stage of diagnosis did not allow to establish the cause of intestinal obstruction. Only the use of laparoscopy made it possible to establish an accurate diagnosis. To date, the question of the need to remove an accidentally found DM remains unresolved. It is believed that an individual approach is advisable. In cases of complications, the choice of surgical intervention depends on the diameter of the diverticulum base, the severity of morphological changes in its wall and the wall of the small intestine. Conclusions. The absence of specific symptoms and low informational content of routine diagnostic methods are the reason for the untimely diagnosis of DM, which often causes the development of severe complications. Laparoscopy is the only significant diagnostic and treatment method that allows for an accurate diagnosis and, in some cases, diverticulectomy. An individual approach is recommended in the treatment of DM, depending on the clinical situation.

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Heterotopic pancreas in Meckel’s diverticulum in an adult man with lower gastrointestinal bleeding: a case report and literature review

Cited by 3 publications

References 19 publications

Endoscopic management of gastric ectopic pancreas with repeated ulcerations and bleeding: A case report

Endoscopic management of gastric ectopic pancreas with repeated ulcerations and bleeding: A case report

Association Between Serum Chloride Levels and 365-Day All-Cause Mortality in Critically IV Patients with Gastrointestinal Bleeding: A Retrospective Cohort Study

A Rare Case of Meckel's Diverticulum Strangulation Complicated by Small Intestine Obstruction (Clinical Case)

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