Incidental diagnosis of gastric antral vascular ectasia in a case of chronic kidney disease from Nepal: a case report.

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Ashish Acharya, Kritika Bhattarai, Abashesh Bhandari
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引用次数: 0

Abstract

Introduction: Gastric antral vascular ectasia is an uncommon clinical disease that affects elder people and is characterized by severe chronic upper gastrointestinal bleeding mainly affecting the gastric antrum. It is generally unusual among patients undergoing maintenance hemodialysis for chronic kidney disease.

Case presentation: Here, we aim to present an uncommon case of incidental diagnosis of the gastric antral vascular ectasia and erosive gastritis in a 71-year-old Hindu male patient belonging to the Gurung ethnicity of Nepal undergoing maintenance hemodialysis due to chronic kidney disease. The patient presented with a history of melena and fatigue. On investigation, a low hemoglobin level of 7.3 gm% was used for blood transfusion. The patient was on regular hemodialysis after admission at our institution. Upper gastrointestinal bleeding was suspected after analyzing patient's history and investigations. Therefore, an upper gastrointestinal endoscopy was performed that showed linear ectatic punctuate lesions radiating from the body of the stomach to the antrum, and hence, an incidental diagnosis of the gastric antral vascular ectasia was made. Initial fluid resuscitation, iron therapy, and a triple regimen were administered. Proper management with argon plasma coagulation therapy was scheduled at another institution due to lack of respective facilities in our institution.

Discussion: Gastric antral vascular ectasia is an unusual cause of upper gastrointestinal bleeding, primarily affecting the gastric antrum and pylorus with rare cases affecting the duodenum, jejunum, and gastric fundus. It is generally associated with other chronic disease conditions. Several hypotheses have been proposed for the pathogenesis of gastric antral vascular ectasia, especially its association with chronic kidney disease, as in our case, which is considered to be rare. Management varies from medical to endoscopic interventions to even surgery.

Conclusion: Prompt proper diagnosis and treatment for the gastric antral vascular ectasia should be sought, as it is frequently misdiagnosed or missed during upper gastrointestinal endoscopy. Our case report presents a case of gastric antral vascular ectasia in chronic kidney disease undergoing maintenance hemodialysis, which is quite uncommon, as literature has suggested the same point.

尼泊尔一例慢性肾病患者被误诊为胃前庭血管异位症:病例报告。
简介胃窦部血管异位症是一种不常见的临床疾病,多发于老年人,主要表现为胃窦部严重的慢性上消化道出血。在接受维持性血液透析治疗的慢性肾病患者中,这种病一般并不常见:在此,我们旨在介绍一例罕见病例,该病例偶发诊断为胃窦前血管异位和糜烂性胃炎,患者为 71 岁印度教男性,尼泊尔古隆族,因慢性肾病接受维持性血液透析。患者有血便和乏力的病史。经检查,血红蛋白水平较低,仅为 7.3 gm%,需要输血。入院后,患者一直在接受定期血液透析。在分析了患者的病史和检查结果后,怀疑是上消化道出血。因此,对其进行了上消化道内镜检查,结果显示其胃体至胃窦呈线状异位点状病变,因此偶然诊断为胃窦血管异位。对患者进行了初步的液体复苏、铁剂治疗和三联疗法。由于本院缺乏相应的设施,因此安排在另一家医院进行氩等离子凝固治疗:讨论:胃前叶血管异位症是上消化道出血的一个不常见原因,主要影响胃窦和幽门,少数病例影响十二指肠、空肠和胃底。它通常与其他慢性疾病相关。关于胃窦部血管异位症的发病机理有几种假说,特别是与慢性肾脏病的关系,就像我们的病例一样,这被认为是罕见的。治疗方法多种多样,从药物治疗到内窥镜干预,甚至手术治疗:结论:胃前区血管异位症经常在上消化道内镜检查中被误诊或漏诊,因此应寻求及时正确的诊断和治疗。我们的病例报告介绍了一例接受维持性血液透析的慢性肾脏病患者的胃前庭血管异位,这在文献中并不常见。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Medical Case Reports
Journal of Medical Case Reports Medicine-Medicine (all)
CiteScore
1.50
自引率
0.00%
发文量
436
期刊介绍: JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
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