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- W3208590152 abstract "Introduction: Colonic neoplasia is a less common but serious cause of acute hematochezia, believed to be responsible for 3-11% of cases of lower GI bleeding (LGIB) in the hospital setting. While most cases of LGIB caused by malignancy tend to be low-grade bleeds from an overlying erosion or ulceration, some LGIB may be the result of arterial bleeds that require more acute intervention. Case Description/Methods: A 93 year-old male with aortic stenosis status post aortic valve repair, coronary artery disease and gout presented after multiple episodes of bloody bowel movement with frank blood on his bedsheets and clothing. Initial CT angiography showed a focus of extravasation consistent with arterial hemorrhage within the cecal lumen. Interventional radiology attempted a superior mesenteric artery embolization but no active bleed was found and colonoscopy was pursued for further assessment of the bleed. Shortly after initiation of colonoscopy prep, the patient was noted to have multiple large volume bloody bowel movements requiring a transfer to the medical ICU for a blood transfusion and close monitoring with continuation of PPI therapy. After the patient was stabilized they underwent colonoscopy, which revealed a non-obstructing 8x6 mm cecal mass and three polyps, all of which were removed. A hemostatic clip was placed without any further bleeding. Pathology confirmed the cecal mass to be a high-grade adenocarcinoma and the patient underwent a full-thickness resection device (FTRD) procedure. Discussion: Most newly-diagnosed colorectal cancer patients with hematochezia rarely present with an acute gastrointestinal bleed requiring emergency admission as most cases involve painless, small-volume bleeds. Arterial lower GI bleeds are typically managed with therapeutic arterial interventions including pharmacologic control with the use of intraarterial vasopressin, embolization with temporary and permanent embolizing materials, and catheter-induced vasospasm. Endoscopic therapy historically has been typically limited given the high risk of bleeding and perforation, although recent advancements, such as the use of TC-325 hemostatic powder, have shown early signs of improved outcomes in immediate hemostasis and rates of recurrent bleeds in the management of malignant Gi bleeds. Additionally, prior research has shown that FTRD is a safe and effective instrument for use in the lower GI tract to treat colorectal lesions. In this patient's case, FTRD was curative from both a hemostatic and oncologic standpoint." @default.
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- W3208590152 date "2021-10-01" @default.
- W3208590152 modified "2023-09-26" @default.
- W3208590152 title "S3596 Not in Vein: A Case of Lower GI Arterial Bleed Due to Cecal Cancer" @default.
- W3208590152 doi "https://doi.org/10.14309/01.ajg.0000787916.17370.c6" @default.
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