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Query: UMLS:C0019079 (hemoptysis)
 6,129 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 78-year-old individual, who had a previous transthoracic Nissen fundoplication 20 years earlier, presented to our institution with hemoptysis. Initial workup included chest roentgenogram, upper gastrointestinal series, and upper endoscopy, all of which were nondiagnostic. A repeat upper endoscopy diagnosed a gastrobronchial fistula by revealing a large gastric ulcer that penetrated into the lung parenchyma. The patient underwent surgery for takedown of the fistula. One of the most common symptoms associated with gastrobronchial fistula is hemoptysis, although insidious cough, recurrent pneumonia, or gastrointestinal bleeding are also observed. The most useful diagnostic study is an upper gastrointestinal series, which must be read with a high index of suspicion. Gastrobronchial fistula is most commonly a long-term complication from hiatal hernia repair. The most frequently used procedure for repair of this disorder is the Nissen fundoplication. This can be done from either an abdominal or transthoracic approach. When the procedure is done such that the gastric wrap is left above the diaphragm, serious complications can occur. These include gastric ulceration, gastric herniation with gastric outlet obstruction, slippage or perforation of the wrap, and gastrobronchial fistula. Because of these serious complications, the Nissen fundoplication with the wrap left above the diaphragm should only be used in certain situations, such as obesity and shortened esophagus.
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PMID:Unusual presentation of hemoptysis in a 78-year-old with previous Nissen fundoplication. 984 51

We report three lethal cases of bleeding to the upper gastrointestinal tract as immediate cause of death. The first two cases are in connection with homelessness. First is a male who was found dead in a railway station, seated on a bench with dried blood beneath him. The second is a male who was found lifeless in a wooden shelter, where upon the good will of the landowners, he lived. At autopsy, gastroduodenal ulcer disease with a damaged blood vessel at the ulcer base was found in both. The cause of death was stated as hypovolemic shock, arising from loss of blood from bleeding gastroduodenal ulcer disease. The third case shows a man with liver cirrhosis, who was transported to hospital when his health deteriorated, where he died with blood vomiting. The case was closed as hypovolemic shock from loss of blood and was ascribed to haemorrhagic diathesis and chronic liver insufficiency, and excluded haemoptysis as the cause of the bleeding. The paper draws attention to the risk of mortality in patients with gastroduodenal ulcer disease, with irregular food intake, including alcohol abuse. The cases demonstrate the importance of medical care for patients who are prone to gastric ulcers, or to patients who have been diagnosed and/or treated for gastroduodenal ulcer disease, as the severe risk of ulcer bleeding, leading eventually to ulcer perforation. Our case reports may inform ambulance crews responding to at-risk individuals, such as homeless people, to the immediate threat of possible gastroduodenal ulcer disease with ulcer bleeding, or ulcer perforation.Key words: bleeding - death - gastric ulcer - gastroduodenal ulcer disease - nutrition - preventive medicine.
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PMID:[Lethal cases of bleeding to the upper gastrointestinal tract]. 2813 33