Displaying publications 41 - 60 of 106 in total

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  1. Concurrent amoebic and histoplasma colitis: a rare cause of massive lower gastrointestinal bleeding
    Koh PS, Roslani AC, Vimal KV, Shariman M, Umasangar R, Lewellyn R
    World J Gastroenterol, 2010 Mar 14;16(10):1296-8.
    PMID: 20222177
    Infective colitis can be a cause of massive lower gastrointestinal bleeding requiring acute surgical intervention. Causative organisms include entamoeba and histoplasma species. However, concurrent colonic infection with both these organisms is very rare, and the in vivo consequences are not known. A 58-year-old male presented initially to the physicians with pyrexia of unknown origin and bloody diarrhea. Amoebic colitis was diagnosed based on biopsies, and he was treated with metronidazole. Five days later, the patient developed massive lower gastrointestinal bleeding with hemorrhagic shock. Emergency total colectomy with end-ileostomy was performed. However, he deteriorated and died on the second postoperative day. Histopathological examination revealed multiple deep ulcers at the hepatic flexure where fungal bodies of mycelial and yeast forms were noted. Isolated lymph nodes showed abscess formation with fungal bodies. Infective fungal colitis with Histoplasma capsilatum was diagnosed. In vitro, amoebic parasites can increase virulence and pathogenicity of histoplasma which may account for the fulminant presentation in this patient. Although rare, this unusual dual infection should be considered in the differential diagnosis of infective colitis, as appropriate antimicrobial treatment may prevent progression to massive lower gastrointestinal bleeding, obviating the need for urgent surgical intervention.
    Matched MeSH terms: Gastrointestinal Hemorrhage/etiology*
  2. Upper gastrointestinal tract bleeding caused by a gastrointestinal stromal tumor of the stomach: a case report
    Al-Hendal A, Al-Sabbagh AJ, Al-Mishaan M, Abo Dief W
    Gulf J Oncolog, 2010 Jul.
    PMID: 20601339
    We report a case of upper gastrointestinal bleeding caused by a gastrointestinal stromal tumor in a 50-year old man. The patient was having melena for two months, and on admission he was hemodynamically stable. Upper G.I endoscopy showed diffuse gastritis and an extrinsic compressing mass in the upper part of the stomach. CT scan of the abdomen showed exophytic mass in the fundus of the stomach, with central necrosis. The patient was submitted to operative management. There were no features of dissemination but there was invasion of the hilum of the spleen. Wide local resection and splenectomy performed. Post operative course was complicated by a bleeding from the anastomotic site that required re-exploration and suturing of the bleeding vessel. Histologic examination revealed that it was composed of spindle-shaped cells with elongated nuclei. Post operatively the patient received adjuvant treatment with Imatinib [Gleevec]. The patient has an uneventful follow-up period so far.
    Matched MeSH terms: Gastrointestinal Hemorrhage/etiology*
  3. Fulltext Chronic rectal bleeding in Proteus syndrome
    Siow SL, Sim NK
    Med J Malaysia, 2010 Dec;65(4):313-4.
    PMID: 21901955
    Proteus Syndrome is a rare congenital hamartomatous disorder that typically manifests itself in overgrowth, vascular malformation and disregulation of fatty tissue. The tissues affected are commonly the limbs but can be of any tissue. Vascular anomalies are common and appear at random sites on the body. Diagnosis is often difficult leading to wrong treatment. We describe a case of a 17-year-old girl with Proteus syndrome presented with symptomatic anaemia secondary to chronic rectal bleeding. Computed Tomography Angiogram of Abdomen and Pelvis confirmed the presence of rectal vascular malformations.
    Matched MeSH terms: Gastrointestinal Hemorrhage/etiology*
  4. Fulltext Factors influencing late consultation among patients with rectal bleeding in University Kebangsaan Malaysia Medical Centre
    Hashim SM, Omar K, Fah TS, Rashid RA, Daud TI, Shah SA, et al.
    Asian Pac J Cancer Prev, 2010;11(5):1335-9.
    PMID: 21198288
    BACKGROUND: Patients' delay in the presentation with rectal bleeding had been identified as a factor for late diagnosis of colorectal cancer. This study was conducted to determine the prevalence of delay in consulting a medical practitioner and identifying associated factors.

    MATERIALS AND METHODS: A cross-sectional study of 80 patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 in the endoscopy unit, University Kebangsaan Malaysia Medical Centre. The self-administered questionnaire included data on sociodemographic, concern of rectal bleeding, whether patients sought initial advice, any self treatment prior to medical consultation and patients' opinion on causes of their own rectal bleeding.

    RESULTS: The prevalence of delay in the presentation of rectal bleeding was 60%. Patients who were less worried (OR 9.6; 95% CI 3.3-27.5), who did not seek anyoneandapos;s advice (OR 11.8; 95% CI 3.8-36.8) and took some treatment before seeking medical consultation (OR 5.0; 95% CI 1.0-24.1) were significantly more likely to delay. Multiple logistic regression revealed that less worry of rectal bleeding and not seeking anyoneandapos;s advice were important predictors (p<0.05). The majority of patients attributed their bleeding to benign causes.

    CONCLUSION: A high proportion of patients with rectal bleeding in the high risk group delayed in seeking medical advice. Public education needs to focus on interventions to reduce the delay in presenting and diagnosis of colorectal carcinoma.
    Matched MeSH terms: Gastrointestinal Hemorrhage/epidemiology*
  5. Fulltext Arteriovenous malformation of the stomach: a rare cause of upper gastrointestinal bleeding
    Latar NH, Phang KS, Yaakub JA, Muhammad R
    Med J Malaysia, 2011 Jun;66(2):142-3.
    PMID: 22106696 MyJurnal
    Haemorrhage arising from gastric arteriovenous malformation (AVM) is rare and normally occurs in the elderly. Bleeding gastric AVM presenting in the younger age group is even rarer. We report a case of a 14 year old boy who presented with recurrent episodes of haematemesis. He subsequently underwent a proximal gastrectomy and the histological examination confirmed a gastric AVM. After reviewing the literature we believe this is the youngest ever reported case of bleeding gastric AVM reported in English literature.
    Matched MeSH terms: Gastrointestinal Hemorrhage/etiology*; Gastrointestinal Hemorrhage/pathology; Gastrointestinal Hemorrhage/therapy
  6. Fulltext Massive lower gastrointestinal bleeding secondary to colonic mucormycosis
    Anand J, Ghazala K, Chong VH
    Med J Malaysia, 2011 Aug;66(3):266-7.
    PMID: 22111457
    Lower gastrointestinal bleeding is usually due to haemorrhoids, diverticular disease, or colorectal cancer. Infective causes of gastrointestinal bleeding are rare. A 70-year-old lady was admitted with septic shock secondary to community acquired pneumonia. She later developed massive lower gastrointestinal bleeding secondary to colonic mucormycosis. Her condition deteriorated rapidly and she died of septicemia. Mucormycosis of the colon is extremely rare and is still associated with a high mortality.
    Matched MeSH terms: Gastrointestinal Hemorrhage/diagnosis; Gastrointestinal Hemorrhage/microbiology*; Gastrointestinal Hemorrhage/therapy
  7. Fulltext Jejunal diverticulosis as the obscure cause of overt gastrointestinal bleeding
    Nyin LY, Zainun AR, Tee HP
    Med J Malaysia, 2011 Aug;66(3):257-8.
    PMID: 22111453 MyJurnal
    Jejunal diverticulosis is a rare gastrointestinal condition manifested as benign outpouching from the jejunal wall. It is usually asymptomatic, but may present as obscure gastrointestinal bleeding. This condition is often found incidentally in the imaging work-up of patients with other gastrointestinal conditions. We present a case of jejunal diverticulosis in a 65-year-old gentleman with obscure overt gastrointestinal bleed.
    Matched MeSH terms: Gastrointestinal Hemorrhage/diagnosis*; Gastrointestinal Hemorrhage/etiology*; Gastrointestinal Hemorrhage/therapy
  8. Fulltext Knowledge of colorectal cancer among patients presenting with rectal bleeding and its association with delay in seeking medical advice
    Mohd Hashim S, Tong SF, Omar K, Abdul Rashid MR, Shah SA, Sagap I
    Asian Pac J Cancer Prev, 2011;12(8):2007-11.
    PMID: 22292642
    BACKGROUND: Knowledge is believed to be a driving factor for patients' early presentation for healthcare. This study was conducted to assess knowledge of colorectal cancer among subjects presenting with rectal bleeding and to determine its association with late presentation.

    METHODS: A cross-sectional study of 80 patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 in the endoscopy unit, University Kebangsaan Malaysia Medical Centre. The research instruments used in this study was a self-administered questionnaire including data on duration of rectal bleeding, first medical consultation and knowledge of colorectal cancer.

    RESULTS: Sixty percent of subjects with rectal bleeding delayed seeking medical advice. Subjects were more aware of symptoms of non-colorectal cancers compared to symptoms of colorectal cancer. The majority of subjects (63.8%) correctly identified rectal bleeding as a symptom but were not aware of the best screening method to detect colorectal cancer. Half of the subjects knew increasing age and genetic background to be risk factors for colorectal carcinoma. However, knowledge of colorectal cancer was not found to be significantly associated with delay in seeking help.

    CONCLUSION: Findings indicate poor awareness of colorectal cancer among the subjects. Although public education of colorectal cancer is important for early presentation on rectal bleeding, further studies are advocated to evaluate other factors influencing patients' help seeking behavior other than knowledge.
    Matched MeSH terms: Gastrointestinal Hemorrhage/etiology*; Gastrointestinal Hemorrhage/pathology; Gastrointestinal Hemorrhage/psychology
  9. Fulltext Chronic Trichuris trichiura Infection Presenting as Ileocecal Valve Swelling Mimicking Malignancy
    Tuan Sharif SE, Ewe Seng C, Mustaffa N, Mohd Shah NA, Mohamed Z
    ISRN Gastroenterol, 2011;2011:105178.
    PMID: 21991493 DOI: 10.5402/2011/105178
    A 46-year-old man presented with a history of passing bright red blood per rectum over the last one month. He also had on and off diarrhea with visible mucus in the stool for two months' duration. Further history was unremarkable, and physical examination revealed hemorrhoids which were subsequently banded. A colonoscopy was arranged in view of the prolonged diarrhea whereby an edematous and swollen ileocecal valve was seen. This was shown to be due to Trichuris trichiura infection, confirmed on histopathological examination of biopsies taken from the site. The patient was started on oral albendazole treatment and has been asymptomatic on latest followup. This case illustrates an accidental finding of T. trichuria infection on colonoscopic examination, which was done to investigate the patient's prolonged diarrhea.
    Matched MeSH terms: Gastrointestinal Hemorrhage
  10. Fulltext Acute lower gastrointestinal haemorrhage secondary to small bowel ascariasis
    Stephen DD, Siow SL
    Malays J Med Sci, 2012 Apr;19(2):92-5.
    PMID: 22973144 MyJurnal
    Acute lower gastrointestinal haemorrhage secondary to small bowel ascariasis is extremely rare. A high level of suspicion should be maintained when dealing with acute gastrointestinal haemorrhage in migrants and travellers. Small bowel examination is warranted when carefully repeated upper and lower endoscopies have failed to elicit the source of bleeding. Appropriate test selection is determined by the availability of local expertise. We present a case of acute lower gastrointestinal haemorrhage secondary to jejunal ascariasis and a literature search on lower gastrointestinal haemorrhage associated with jejunal infestation with Ascaris.
    Matched MeSH terms: Gastrointestinal Hemorrhage
  11. Fulltext Spontaneous intramural oesophageal haematoma: a case report
    Seneviratne SA, Kumara DS, Drahaman A
    Med J Malaysia, 2012 Oct;67(5):536-7.
    PMID: 23770878
    Spontaneous intramural oesophageal haematoma is a rare disease and presents with the classic triad of symptoms of chest pain, dysphagia and haematemesis. Flexible oesophagoscopy and contrast enhanced CT scan is helpful in the diagnosis and also to exclude other sinister pathologies. Most are managed conservatively and the patient we report also was managed conservatively with a successful outcome.
    Matched MeSH terms: Gastrointestinal Hemorrhage
  12. Lethal hemorrhage from a ureteric-arterial-enteric fistula diagnosed by postmortem CT angiography
    Rashid SN, Bouwer H, O'Donnell C
    Forensic Sci Med Pathol, 2012 Dec;8(4):430-5.
    PMID: 22477359 DOI: 10.1007/s12024-012-9332-3
    Fistula formation following pelvic surgery and radiotherapy, including ureteric-arterial fistulas (UAF), is well documented, however, ureteric-arterial-enteric fistula is extremely rare. Conventional autopsy is usually required for the definitive diagnosis of pelvic vascular fistulas although an accurate diagnosis can still be complicated and challenging. The role of post-mortem computed tomography (PMCT) as an adjunct to conventional autopsy is well documented in the literature. One of the limitations of PMCT is the diagnosis of vascular conditions. Post-mortem computed tomography angiography (PMCTA) is a recently introduced technique that can assist in detecting such pathology. We present a case of post-radiotherapy ureteric-arterial-enteric fistula presenting as massive rectal and vaginal bleeding diagnosed prior to autopsy on PMCTA. The role of PMCTA in the diagnosis of such a UAF has not previously been reported in the literature.
    Matched MeSH terms: Gastrointestinal Hemorrhage/etiology; Gastrointestinal Hemorrhage/pathology
  13. A rare case of intussusception associated with metastasized small cell carcinoma of lung
    Jarmin R, Azman A, Rahim R, Kosai NR, Das S
    Acta Med Iran, 2012;50(11):782-4.
    PMID: 23292632
    Intussusception is common cause of bowel obstruction in the paediatric age group compared to the elderly population. Many times, the diagnosis may be difficult because of asymptomatic nature of this bowel disorder. We hereby describe the case of a 75-year-old male who presented with lethargy, weakness, loss of movement in the joints and was found to be anemic. The haemoglobin level was low so he was transfused with packed cells. On gastrointestinal (GI) endoscopy, upper GI bleed was observed. A mass was observed beyond ampulla at the 2nd and 3rd part of the duodenal junction. Computerized tomography (CT) scan also showed a mass at the head of pancreas and the lesion at the left lung. In view of persistent bleed, 'Whipple's procedure' was performed. Histopathological examination showed small cell carcinoma of the lungs with metastasis to the pancreas and the jejunum. We here discuss the case of intussusception with intestinal metastasis which presented with gastrointestinal bleeding.
    Matched MeSH terms: Gastrointestinal Hemorrhage/complications; Gastrointestinal Hemorrhage/etiology*; Gastrointestinal Hemorrhage/surgery
  14. Statements of the Malaysian Society of Gastroenterology & Hepatology and the National Heart Association of Malaysia task force 2012 working party on the use of antiplatelet therapy and proton pump inhibitors in the prevention of gastrointestinal bleeding
    Tan HJ, Mahadeva S, Menon J, Ng WK, Zainal Abidin I, Chan FK, et al.
    J Dig Dis, 2013 Jan;14(1):1-10.
    PMID: 23134105 DOI: 10.1111/1751-2980.12000
    The working party statements aim to provide evidence and guidelines to practising doctors on the use of antiplatelet therapy and proton pump inhibitors (PPIs) in patients with cardiovascular risk as well as those at risk of gastrointestinal (GI) bleeding. Balancing the GI and cardiovascular risk and benefits of antiplatelet therapy and PPIs may sometimes pose a significant challenge to doctors. Concomitant use of anti-secretory medications has been shown to reduce the risk of GI bleeding but concerns have been raised on the potential interaction of PPIs and clopidogrel. Many new data have emerged on this topic but some can be confusing and at times controversial. These statements examined the supporting evidence in four main areas: rationale for antiplatelet therapy, risk factors of GI bleeding, PPI-clopidogrel interactions and timing for recommencing antiplatelet therapy after GI bleeding, and made appropriate recommendations.
    Matched MeSH terms: Gastrointestinal Hemorrhage/chemically induced; Gastrointestinal Hemorrhage/prevention & control*
  15. Fulltext Management of bleeding pseudoaneurysm of gastroduodenal artery secondary to chronic pancreatitis
    Leow VM, Siam F, Kannan S, Sari Baharudin M, Raman K, Singh H
    Med J Malaysia, 2013 Jun;68(3):271-2.
    PMID: 23749023 MyJurnal
    A bleeding pseudoaneurysm of the peripancreatic artery can present with massive upper gastrointestinal hemorrhage. History of pancreatitis and urgent imaging are crucial in the making of the diagnosis. Here, we report a patient with alcoholic chronic pancreatitis presented with ruptured pseudoaneurysm of gastroduodenal artery (GDA). He was treated with percutaneous angiographic embolisation.
    Matched MeSH terms: Gastrointestinal Hemorrhage/therapy
  16. Jaundice and life-threatening hemobilia: an uncommon presentation of choledochal cyst
    Koh PS, Yoong BK, Vijayananthan A, Nawawi O, Mahadeva S
    J Dig Dis, 2013 Aug;14(8):451-4.
    PMID: 23324023 DOI: 10.1111/1751-2980.12036
    Hemobilia with jaundice as a result of cholestasis and bleeding from choledochal cyst is uncommon. Ascertaining the diagnosis is often challenging and delayed diagnosis can lead to significant consequences due to hemodynamic instability, particularly in elderly patients. Although surgery remains the definitive treatment modality, interventional radiology for hemostasis has been increasingly recognized as an option. In this manuscript, we described two Malaysian cases of jaundice and hemobilia associated with choledochal cysts and the challenges related with clinical diagnosis and management.
    Matched MeSH terms: Gastrointestinal Hemorrhage/etiology
  17. Fulltext Gastroprotective effects of Corchorus olitorius leaf extract against ethanol-induced gastric mucosal hemorrhagic lesions in rats
    Al Batran R, Al-Bayaty F, Abdulla MA, Al-Obaidi MM, Hajrezaei M, Hassandarvish P, et al.
    J Gastroenterol Hepatol, 2013 Aug;28(8):1321-9.
    PMID: 23611708 DOI: 10.1111/jgh.12229
    BACKGROUND AND AIM: Corchorus olitorius is a medicinal plant traditionally utilized as an antifertility, anti-convulsive, and purgative agent. This study aimed to evaluate the gastroprotective effect of an ethanolic extract of C. olitorius against ethanol-induced gastric ulcers in adult Sprague Dawley rats.

    METHODS: The rats were divided into seven groups according to their pretreatment: an untreated control group, an ulcer control group, a reference control group (20 mg/kg omeprazole), and four experimental groups (50, 100, 200, or 400 mg/kg of extract). Carboxymethyl cellulose was the vehicle for the agents. Prior to the induction of gastric ulcers with absolute ethanol, the rats in each group were pretreated orally. An hour later, the rats were sacrificed, and gastric tissues were collected to evaluate the ulcers and to measure enzymatic activity. The tissues were subjected to histological and immunohistochemical evaluations.

    RESULTS: Compared with the extensive mucosal damage in the ulcer control group, gross evaluation revealed a marked protection of the gastric mucosa in the experimental groups, with significantly preserved gastric wall mucus. In these groups, superoxide dismutase and malondialdehyde levels were significantly increased (P < 0.05) and reduced (P < 0.05), respectively. In addition to the histologic analyses (HE and periodic acid-Schiff staining), immunohistochemistry confirmed the protection through the upregulation of Hsp70 and the downregulation of Bax proteins. The gastroprotection of the experimental groups was comparable to that of the reference control medicine omeprazole.

    CONCLUSIONS: Our study reports the gastroprotective property of an ethanolic extract of C. olitorius against ethanol-induced gastric mucosal hemorrhagic lesions in rats.

    Matched MeSH terms: Gastrointestinal Hemorrhage/chemically induced*; Gastrointestinal Hemorrhage/metabolism; Gastrointestinal Hemorrhage/pathology; Gastrointestinal Hemorrhage/prevention & control*
  18. Fulltext Gastroprotection studies of Schiff base zinc (II) derivative complex against acute superficial hemorrhagic mucosal lesions in rats
    Golbabapour S, Gwaram NS, Hassandarvish P, Hajrezaie M, Kamalidehghan B, Abdulla MA, et al.
    PLoS One, 2013;8(9):e75036.
    PMID: 24058648 DOI: 10.1371/journal.pone.0075036
    The study was carried out to assess the gastroprotective effect of the zinc (II) complex against ethanol-induced acute hemorrhagic lesions in rats.
    Matched MeSH terms: Gastrointestinal Hemorrhage/chemically induced; Gastrointestinal Hemorrhage/drug therapy*; Gastrointestinal Hemorrhage/metabolism; Gastrointestinal Hemorrhage/pathology
  19. Arterial embolization of a bleeding gastric Dieulafoy lesion: a case report
    Mohd Rizal MY, Kosai NR, Sutton PA, Rozman Z, Razman J, Harunarashid H, et al.
    Clin Ter, 2013;164(1):25-7.
    PMID: 23455738 DOI: 10.7417/T.2013.1506
    Dieulafoy's lesion is one of an unusual cause of upper gastrointestinal bleeding (U GIB). Endoscopic intervention has always been a preferred non-surgical method in treating UGIB including bleeding from Dieulafoy's lesion. Owing to recent advances in angiography, arterial embolization has become a popular alternative in non- variceal UGIB especially in cases with failed endoscopic treatment. However, managing bleeding Dieulafoy's with selective arterial embolization as the first line of treatment has not been exclusively practiced. We hereby, report a case of bleeding Dieulafoy lesion which had been primarily treated with arterial embolization.
    Matched MeSH terms: Gastrointestinal Hemorrhage/complications*; Gastrointestinal Hemorrhage/diagnosis; Gastrointestinal Hemorrhage/etiology; Gastrointestinal Hemorrhage/therapy*
  20. Fulltext Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding
    Lee YY, Tee HP, Mahadeva S
    World J Gastroenterol, 2014 Feb 21;20(7):1790-6.
    PMID: 24587656 DOI: 10.3748/wjg.v20.i7.1790
    Bacterial infections are common in cirrhotic patients with acute variceal bleeding, occurring in 20% within 48 h. Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection. However, mortality from variceal bleeding is largely determined by the severity of liver disease. Besides a higher Child-Pugh score, patients with hepatocellular carcinoma are particularly susceptible to infections. Despite several hypotheses that include increased use of instruments, greater risk of aspiration pneumonia and higher bacterial translocation, it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis. Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures, but more recently, gram positives and quinolone-resistant organisms are increasingly seen, even though their clinical significance is unclear. Fluoroquinolones (including ciprofloxacin and norfloxacin) used for short term (7 d) have the most robust evidence and are recommended in most expert guidelines. Short term intravenous cephalosporin (especially ceftriaxone), given in a hospital setting with prevalent quinolone-resistant organisms, has been shown in studies to be beneficial, particularly in high risk patients with advanced cirrhosis.
    Matched MeSH terms: Gastrointestinal Hemorrhage/mortality
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