[The Apt test in melena of the newborn (differential diagnosis between melena vera and melena spurial)].
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Diagnosis, Differential↗
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Diagnostic considerations in evaluation of patients presenting with melena and nondiagnostic esophagogastroduodenoscopy.
Proper evaluation of patients with melena and nondiagnostic esophagogastroduodenoscopy is comparatively undefined. We sought to determine the percentage of patients with melena and nondiagnostic upper endoscopy and assess the yield of further evaluation. Of 209 patients presenting with melena, 180 underwent esophagogastroduodenoscopy as the initial study, which was nondiagnostic in 43 cases (24%). Further evaluation was pursued in 30. A presumed source of melena was found in 11 patients (37%), identified by colonoscopy in seven, bleeding scan in three, and barium enema plus flexible sigmoidoscopy in one. Nearly all such defined cases originated from the right colon. Small bowel contrast studies, flexible sigmoidoscopy of barium enema alone, and angiography failed to reveal a source. Our findings suggest that many (24%) patients presenting with melena will have nondiagnostic upper endoscopy; further evaluation reveals a potential source in 37% of this group, with the right colon being the most likely location of pathology; and colonoscopy is the test of choice in this cohort.
Adolescent↗
Investigation of melena and hematochezia as the chief complaint of gastrointestinal bleeding in pediatric surgical patients.
The causes of melena or hematochezia in 48 pediatric patients were examined. Malrotation with volvulus was an important cause of hemorrhage during the newborn period, and intussusception was very typical in patients aged from 1 month to 1 year. Polyps of the rectum and colon were the most common causes of melena or hematochezia in patients older than 1 year. No cause of melena or hematochezia could be identified in 11 children. Ten patients have remained in good health with no further episodes of melena or hematochezia. Localized multiple polyps of the rectum with focal carcinoma were detected in only one patient. In general, although no further investigation is required after detection of the cause of bleeding and its successful treatment, it should be kept in mind that gastrointestinal malignancy can occur in children.
Adolescent↗
A case of melena caused by a hepatic aneurysm ruptured into the intrahepatic bile duct in a patient with allergic granulomatous angiitis.
A 46 year old woman was admitted to our institute in June, 1987 with an attack of asthma, as well as remittent fever and leukocytosis accompanied by hypereosinophilia. She was found to have melena from an unknown source upon gastrointestinal examination. Four low-density areas were found in the liver on computed tomography and one of the intrahepatic foci formed a large extrahepatic abscess communicating with the intrahepatic duct on tubography. Resection of the four hepatic segments, including the large abscess, and cholecystectomy were performed. Healed necrotizing arteritis was histopathologically observed in the resected liver specimen, with the four low-density areas on CT scan having all been necrotic foci. One of them formed an intrahepatic biliary fistula and rupture of a hepatic aneurysm into a biliary duct was found to be the cause of melena. Although eosinophil infiltration and extravascular granuloma were not observed, a diagnosis of allergic granulomatous angiitis was made from the characteristic clinical course, systemic vasculitis and peripheral blood eosinophilia. To the best of our knowledge, this is the first report of intrahepatic duct perforation most probably being caused by hepatic aneurysm rupture in a patient with allergic granulomatous angiitis.
Aneurysm↗
Epistaxis as a cause of hematemesis and melena.
Epistaxis was diagnosed in 10 patients with apparent upper gastrointestinal bleeding, comprising a 0.55% incidence of hematemesis and melena in the population studied. A sufficient amount of blood can be swallowed during epistaxis to cause hematemesis and melena. Recent facial trauma or epistaxis, absence of a history of chronic dyspepsia, and impairment of blood coagulation emerge as strong indicators of the diagnosis and should lead to a careful examination of the nose and nasopharynx for the source of bleeding.
Adult↗
[Campylobacter enterocolitis complaining of melena].
A 38-year-old man was admitted to our hospital complaining of 5 episodes of melena without abdominal pain or diarrhea. No abnormalities were noted through an upper gastrointestinal endoscopy, but a proctoscopy revealed a large amount of coagulated blood within the rectum immediately before his admission. A colonoscopy revealed spotty redness with dark-red coagulation in the region from the splenic flexure down to the rectum except oral colon beyond the transverse colon. A presumptive diagnosis of campylobacter enterocolitis was made by a microscopy performed on the stool specimen, then an oral administration of erythromycin was started. A colonoscopy done on the 5th hospital day proved improvement on the mucosal changes. The final diagnosis of campylobacter enterocolitis was made by the stool culture. The patient took a satisfactory course of hospitalization and was discharged on the 10th day. Bacteriological examination of stool specimen together with endoscopy has been confirmed to be useful for the diagnosis of melena cases without manifestation of infectious enterocolitis.
Adult↗
Effectiveness of high-dose intravenous immunoglobulin in a case of acquired von Willebrand syndrome with chronic melena not responsive to desmopressin and factor VIII concentrate.
A patient with benign monoclonal IgG lambda paraproteinemia, acquired von Willebrand syndrome (AVWS), and chronic melena successfully responding to high-dose intravenous immunoglobulin (lvlg) is reported. Coagulation parameters at admission were APTT (ratio) 1.68; VIII:C 11 IU/dL; vWF:Ag 7 IU/dL:Ricof less than 3 IU/dl. RIPA was greater than 1.8 mg/ml, and bleeding time (BT) was prolonged (18 min). No evidence for an in vitro inhibitor against the VIII/vWF complex was observed. VIII/vWF measurements showed a short-lived increase after both DDAVP and Hemate P, and BT was transiently normalized. After intravenous Ig (1 g/kg for 2 days), VIII/vWF measurements, hemostatic parameters and multimeric pattern were completely corrected (VIII/C 106 IU/dl, vWF:Ag 168 IU/dl, RiCof 147 IU/dl, APTT ratio 0.89, BT 5'), with a return to pre-infusion values after 15 days. Hemoccult test became negative and packed red cell transfusions, of which 130 units were administered during the last year, were no longer required. After 18 months the patient is on maintenance treatment with repeated courses of Ig, at 3 to 4-week intervals based on VIII/vWF and BT monitoring.
Bleeding Time↗
Cow's milk intolerance with melena.
The clinical features, the results of gastric secretory function tests, and the duodenojejunal morphology of six infants (aged 0.42-1.23 years) with anemia and melena considered to be due to latent cow's milk intolerance (LCMI) were compared with the findings in nine infants (aged 0.19-0.87 years) with cow's milk-induced malabsorption (CMI). The infants with LCMI had a short period of breast feeding, normal weight gain without symptoms of malabsorption, and no atopic history. The maximal acid secretion was decreased (p < 0.01) and the concentration of fasting serum gastrin raised (p < 0.01) compared with the controls. Gastric biopsy revealed epithelial degeneration in three and erosion in one out of four samples. The duodenojejunal biopsy revealed slight changes in two samples, the others being normal. The number of eosinophils was increased in four out of six biopsies. Although the number of intraepithelial lymphocytes was increased in LCMI the rise was not as significant as in children with CMI (p < 0.05). We conclude from our results that LCMI seems to be a seperate clinical entity. The determination of fasting serum gastrin, maximal gastric acid secretion and intraepithelial lymphocytes on duodenojejunal biopsy appear to be helpful in making the diagnosis.
Animals↗
Frank melena in a patient with fallopian tube pregnancy.
We present herein a case of a young woman who experienced lower intestinal hemorrhage caused by ischemic necrosis of the small intestine induced by the compression of a Fallopian tube hematoma in an ectopic pregnancy. All accessible preoperative attempts to clear the site of the bleeding were unsuccessful and an exploratory laparotomy was indicated seventeen days after the development of melena. An ileocecal resection and right salpingectomy finally had to be performed.
Adult↗
Schwannoma of the duodenum causing melena.
A rare case of duodenal schwannoma is reported. A 69-year-old man was admitted for evaluation of melena. Endoscopy and hypotonic duodenography showed a submucosal tumor in the third part of the duodenum. Biopsy findings were suggestive of leiomyosarcoma, therefore pancreatoduodenectomy was performed. Hematoxylin-eosin staining of the resected specimen showed interlacing bundles of spindle-shaped cells with palisading nuclei. Immunohistochemical staining showed positivity for S-100 protein and neuron-specific enolase, but desmin was negative, thus a diagnosis of schwannoma was made. Schwannoma is often difficult to distinguish from leiomyogenic tumors by standard staining, but immunohistochemical staining proved useful in this case.
Aged↗
Symptoms in patients with peptic ulcer and hematemesis and/or melena related to the use of non-steroid anti-inflammatory drugs.
One hundred and seven consecutive patients with hematemesis and/or melena and a diagnosis of duodenal, gastric, or esophageal ulcers were interviewed immediately before or after endoscopy about the use of non-steroid anti-inflammatory drugs (NSAIDs) and symptoms before the hemorrhage. If the patients admitted no symptoms of abdominal pain or discomfort, nausea, vomiting, or heartburn, they were classified as having no ulcer symptoms before the hemorrhage. Patients who had not taken NSAIDs during the last 48 h before the hemorrhage were classified as not having taken NSAIDs. Significantly fewer patients had ulcer symptoms in the group that had used NSAIDs than in the other group (p less than 0.01). This may be interpreted as a possible masking effect by NSAIDs on ulcer symptoms. Physicians and patients should be aware of this possible effect of NSAIDs.
Anti-Inflammatory Agents, Non-Steroidal↗
Same-day upper and lower endoscopy in patients with occult bleeding, melena, hematochezia, and/or microcytic anemia. A retrospective study of 224 patients.
The purpose of this study was to evaluate the role of same-day upper and lower endoscopy in patients investigated for non-acute gastrointestinal bleeding, manifested by occult bleeding, melena, or hematochezia and/or anemia suspected to be caused by gastrointestinal bleeding. A total of 224 patients, 127 women and 97 men, were reviewed. A potential bleeding source (PBS) in the upper gastrointestinal tract could have been missed in 25% of the patients if only colonoscopy had been performed. In nearly the same proportion of patients (26%) a potential bleeding source could have been missed if only esophagogastroduodenoscopy had been performed. Nine per cent of the patients had a potential bleeding source in both locations. Forty-six per cent (19 of 41) of the patients with a PBS in colon, other than colonic cancer, had a PBS also in the upper gastrointestinal tract. The chance of finding a potential bleeding source in patients with microcytic anemia and positive Hemoccult test is threefold higher than for the patients with microcytic anemia and negative Hemoccult test and twofold higher than in patients with normal blood hemoglobin value but positive Hemoccult test. Moreover, 22% (8 of 36) of the patients with microcytic anemia and a positive Hemoccult test had colonic carcinoma. Approximately 30% of the patients with a PBS had two or more PBSs in one or more organs. Eighteen per cent of 43 patients with a history of upper gastrointestinal symptoms had a PBS in the upper gastrointestinal tract. The corresponding figure for the patients without a history of upper gastrointestinal symptoms was 29%.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Intractable diarrhea and melena in an AIDS patient.
A young Arab male, clinically suspected to have ulcerative colitis, was operated upon for fulminant intractable diarrhea with melena. The colon showed severe necrotizing and hemorrhagic colitis which was attributed to an opportunistic infection, viz cytomegalovirus infection. The patient's immunocompromised state was a consequence of AIDS, proved by ELISA and Western Blot test. He subsequently developed multiple brain abscesses and succumbed to uncontrolled infection.
Acquired Immunodeficiency Syndrome↗
[Adult T-cell leukemia with massive melena due to marked gastrointestinal involvement].
A 60-year-old man born in Okinawa was admitted to our hospital because of epigastralgia. Physical examination revealed general lymphadenopathy, mild hepatomegaly and skin eruption. The peripheral blood leukocyte count was 168,600/microliters, with 93% abnormal lymphocytes showing convoluted or lobulated nuclei. Anti HTLV-1 antibody was positive with titer of 1: 1280 (PA). Leukemic cells had typical ATL cells' surface markers (OKT3; 97.2%, T4; 93.3%, T8; 2.8%, OKIA1; 39.6%, IL-2R; 41.8%) and complete monoclonal HTLV-1 provirus DNA. Endoscopic examination with biopsy revealed massive involvement of ATL cells into gastric mucosa. In the course of the treatment, he had extremely massive melena, and was saved by emergency operation. Multiple ulcers were found in the resected colon. Histological examination showed the marked infiltration of the ATL cells into the mucous or submucous membrane. Thereafter, he was treated well with ALG (Anti Lymphocyte Globulin), until hypercalcemia occurred. He died of acute renal failure after hypercalcemia.
Gastrointestinal Neoplasms↗
[A study of cases of early gastric cancer with hematemesis and/or melena].
In this hospital, gastric cancers showed a slightly lower incidence (9.3%) of hematemesis and/or melena than gastric ulcers (13.9%), and no distinct difference in such incidence between early gastric cancers and advanced gastric cancers was observed. A study of the literature on early gastric cancers presenting such symptoms revealed that male patients showed an extremely high incidence of these symptoms, as did those with depressed lesions, including types II c + III, and lesions occurring in the MC-C regions dominated by the left gastric artery.
Adult↗
Hematemesis and Melena: gastritis.
The records of a total of 60 gastritis patients who showed hematemesis and/or melena are reviewed. The mean age was 40. The ratio of males to females was two to one. During the examination, 19 upper G-I lesions were confirmed in addition to gastritis. Sixteen patients had severe underlying diseases which were thought to be the cause of the bleeding tendency. Thirteen patients took alcohol or drugs which induced bleeding. Prognoses of the patients were relatively good when they were treated medically.
Adolescent↗
Management of massive melena of undetermined origin.
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Disease Management↗
MELENA DUE TO ADENOMA OF THE AMPULLA OF VATER.
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Adenoma↗