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Title: Gastrointestinal Amyloidosis Presenting with Multiple Episodes of Gastrointestinal Bleeding

Abstract

Amyloidosis is characterized by the extracellular deposition of amyloid protein in various organs. Gastrointestinal involvement in amyloidosis is common, but a diagnosis of amyloidosis is often delayed. Severe gastrointestinal hemorrhage in amyloidosis is rare but can be fatal in some cases. We experienced a case of a 49-year-old man who presented with recurrent massive hematochezia. Although embolization was performed eight times for bleeding from different sites of the small intestine, hematochezia did not cease. We report the case, with a review of the literature.

Authors:
; ; ;  [1];  [2]; ; ;  [1]
  1. Dong-A University Hospital, Department of Diagnostic Radiology (Korea, Republic of)
  2. College of Medicine, Dong-A University, Department of Pathology (Korea, Republic of)
Publication Date:
OSTI Identifier:
21428559
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 32; Journal Issue: 3; Other Information: DOI: 10.1007/s00270-008-9429-y; Copyright (c) 2009 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Article Copyright (c) 2008 Springer Science+Business Media, LLC
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; DEPOSITION; HEMORRHAGE; PROTEINS; REVIEWS; SMALL INTESTINE; BODY; DIGESTIVE SYSTEM; DOCUMENT TYPES; GASTROINTESTINAL TRACT; INTESTINES; ORGANIC COMPOUNDS; ORGANS; PATHOLOGICAL CHANGES; SYMPTOMS

Citation Formats

Kim, Sang Hyeon, E-mail: g4439@naver.com, Kang, Eun Ju, Park, Jee Won, Jo, Jung Hyun, Kim, Soo Jin, Cho, Jin Han, Kang, Myong Jin, and Park, Byeong Ho. Gastrointestinal Amyloidosis Presenting with Multiple Episodes of Gastrointestinal Bleeding. United States: N. p., 2009. Web. doi:10.1007/S00270-008-9429-Y.
Kim, Sang Hyeon, E-mail: g4439@naver.com, Kang, Eun Ju, Park, Jee Won, Jo, Jung Hyun, Kim, Soo Jin, Cho, Jin Han, Kang, Myong Jin, & Park, Byeong Ho. Gastrointestinal Amyloidosis Presenting with Multiple Episodes of Gastrointestinal Bleeding. United States. doi:10.1007/S00270-008-9429-Y.
Kim, Sang Hyeon, E-mail: g4439@naver.com, Kang, Eun Ju, Park, Jee Won, Jo, Jung Hyun, Kim, Soo Jin, Cho, Jin Han, Kang, Myong Jin, and Park, Byeong Ho. Fri . "Gastrointestinal Amyloidosis Presenting with Multiple Episodes of Gastrointestinal Bleeding". United States. doi:10.1007/S00270-008-9429-Y.
@article{osti_21428559,
title = {Gastrointestinal Amyloidosis Presenting with Multiple Episodes of Gastrointestinal Bleeding},
author = {Kim, Sang Hyeon, E-mail: g4439@naver.com and Kang, Eun Ju and Park, Jee Won and Jo, Jung Hyun and Kim, Soo Jin and Cho, Jin Han and Kang, Myong Jin and Park, Byeong Ho},
abstractNote = {Amyloidosis is characterized by the extracellular deposition of amyloid protein in various organs. Gastrointestinal involvement in amyloidosis is common, but a diagnosis of amyloidosis is often delayed. Severe gastrointestinal hemorrhage in amyloidosis is rare but can be fatal in some cases. We experienced a case of a 49-year-old man who presented with recurrent massive hematochezia. Although embolization was performed eight times for bleeding from different sites of the small intestine, hematochezia did not cease. We report the case, with a review of the literature.},
doi = {10.1007/S00270-008-9429-Y},
journal = {Cardiovascular and Interventional Radiology},
number = 3,
volume = 32,
place = {United States},
year = {Fri May 15 00:00:00 EDT 2009},
month = {Fri May 15 00:00:00 EDT 2009}
}
  • Short communication.
  • Proponents of (/sup 99m/Tc)sulfur colloid for GI bleeding studies argue that, although labeled red blood cells are useful for intermittent bleeding, they are not capable of detecting low bleeding rates. Studies of dogs with experimental GI bleeding have indicated bleeding rates of 0.05 ml/min can be detected with (/sup 99m/Tc)sulfur colloid. Since similar data in the dog model were unavailable for /sup 99m/Tc-labeled red blood cells, we undertook this study. To simulate lower GI bleeding, catheters were inserted into the bowel lumen. Each dog's blood was labeled with /sup 99m/Tc using an in vitro technique. Venous blood was then withdrawnmore » and re-infused into the lumen of the bowel using a Harvard pump. Fourteen dogs were studied, ten receiving a bleeding rate from 4.6-0.02 ml/min in the descending colon and four with proximal jejunal bleeds of 0.20-0.02 ml/min. Bleeding rates of 4.6-0.2 ml/min were detected within 10 min in the colon and bleeding rates as low as 0.04 ml/min were seen by 55 min. Slower bleeding rates were not detected. Similar findings were noted for proximal jejunal bleeds. Based on the time of appearance, a minimum volume of approximately 2-3 ml labeled blood was necessary to detect bleeding. We conclude that /sup 99m/Tc-labeled RBCs are sensitive for low bleeding rates in the dog model. The rates are comparable to those described for (/sup 99m/Tc)sulfur colloid in this experimental setting. The time of appearance of activity is related to the bleeding rate.« less
  • The normal appearance of a gastrointestinal bleeding study using labeled red blood cells has been discussed frequently, but the actual appearance is not well known. In this atlas article, the authors report on unusual findings in non-bleeding subjects and have tabulated the visualization of various structures. Vascular structures other than the aorta and inferior vena cava were seen in 42 of 48 patients. One or both kidneys were seen in 10 (21%) of 48 patients. The urinary bladder was seen in 23 (48%) of 48 patients, although gastric activity caused by free pertechnetate was never observed.
  • Purpose: To identify the dosimetric parameters associated with gastrointestinal (GI) toxicity in patients with locally advanced pancreatic cancer (LAPC) treated with gemcitabine-based chemoradiotherapy. Methods and Materials: The data from 40 patients were analyzed retrospectively. Chemoradiotherapy consisted of conventional fractionated three-dimensional radiotherapy and weekly gemcitabine. Treatment-related acute GI toxicity and upper GI bleeding (UGB) were graded according to the Common Toxicity Criteria Adverse Events, version 4.0. The dosimetric parameters (mean dose, maximal absolute dose which covers 2 cm{sup 3} of the organ, and absolute volume receiving 10-50 Gy [V{sub 10-50}]) of the stomach, duodenum, small intestine, and a composite structure ofmore » the stomach and duodenum (StoDuo) were obtained. The planning target volume was also obtained. Univariate analyses were performed to identify the predictive factors for the risk of grade 2 or greater acute GI toxicity and grade 3 or greater UGB, respectively. Results: The median follow-up period was 15.7 months (range, 4-37). The actual incidence of acute GI toxicity was 33%. The estimated incidence of UGB at 1 year was 20%. Regarding acute GI toxicity, a V{sub 50} of {>=}16 cm{sup 3} of the stomach was the best predictor, and the actual incidence in patients with V{sub 50} <16 cm{sup 3} of the stomach vs. those with V{sub 50} of {>=}16 cm{sup 3} was 9% vs. 61%, respectively (p = 0.001). Regarding UGB, V{sub 50} of {>=}33 cm{sup 3} of the StoDuo was the best predictor, and the estimated incidence at 1 year in patients with V{sub 50} <33 cm{sup 3} of the StoDuo vs. those with V{sub 50} {>=}33 cm{sup 3} was 0% vs. 44%, respectively (p = 0.002). The dosimetric parameters correlated highly with one another. Conclusion: The irradiated absolute volume of the stomach and duodenum are important for the risk of acute GI toxicity and UGB. These results could be helpful in escalating the radiation doses using novel techniques, such as intensity-modulated radiotherapy, for the treatment of pancreatic cancer.« less
  • PurposeTo evaluate the effectiveness of transcatheter arterial embolization (TAE) for gastrointestinal (GI) bleeding caused by GI lymphoma.Materials and MethodsThe medical records of 11 patients who underwent TAE for GI bleeding caused by GI lymphoma between 2001 and 2015 were reviewed retrospectively.ResultsA total of 20 TAE procedures were performed. On angiography, contrast extravasation, and both contrast extravasation and tumor staining were seen in 95 % (19/20) and 5 % (1/20) of the procedures, respectively. The most frequently embolized arteries were jejunal (n = 13) and ileal (n = 5) branches. Technical and clinical success rates were 100 % (20/20) and 27 % (3/11), respectively. The causes of clinical failuremore » in eight patients were rebleeding at new sites. In four patients who underwent repeat angiography, the bleeding focus was new each time. Three patients underwent small bowel resection due to rebleeding after one (n = 2) or four (n = 1) times of TAEs. Another two patients underwent small bowel resection due to small bowel ischemia/perforation after three or four times of TAEs. The 30-day mortality rate was 18 % due to hypovolemic shock (n = 1) and multiorgan failure (n = 1).ConclusionAngiogram with TAE shows limited therapeutic efficacy to manage GI lymphoma-related bleeding due to high rebleeding at new sites. Although TAE can be an initial hemostatic measure, surgery should be considered for rebleeding due to possible bowel ischemic complication after repeated TAE procedures.« less