Hematemesis

BackgroundVideolaryngoscopes may not be useful in the presence of hematemesis or vomitus. We compared the utility of the Macintosh laryngoscope (McL), which is a direct laryngoscope, with that of the Pentax-AWS Airwayscope (AWS) and McGRATH MAC (McGRATH), which are videolaryngoscopes, in simulated hematemesis and vomitus settings.MethodsSeventeen anesthesiologists with more than 1 year of experience performed tracheal intubation on an adult manikin using McL, AWS, and McGRATH under normal, hematemesis, and vomitus simulations.ResultsIn the normal setting, the intubation success rate was 100% for all three laryngoscopes. In the hematemesis settings, the intubation success rate differed significantly among the three laryngoscopes (P = 0.021). In the vomitus settings, all participants succeeded in tracheal intubation with McL or McGRATH, while five failed in the AWS trial with significant difference (P = 0.003). The intubation time did not significantly differ in normal settings, while it was significantly longer in the AWS trial compared to McL or McGRATH trial in the hematemesis or vomitus settings (P ConclusionThe performance of McGRATH and McL can be superior to that of AWS for tracheal intubation in vomitus and hematemesis settings in adults.

BackgroundGastrointestinal bleeding is one of the major gastrointestinal diseases. In this study, our objective was to compare Glasgow-Blatchford score (GBS), AIMS65 score, MAP score, Modified GBS, and Iino score as outcome measures for upper gastrointestinal bleeding. In addition, we extracted factors associated with hemostatic procedures including endoscopy, and proposed a new robust score model.MethodsFrom January 2015 to December 2019, 675 patients with symptoms such as hematemesis who visited the National Hospital Organization Disaster Medical Center and underwent urgent upper endoscopy with diagnosis of suspected non-variceal upper gastrointestinal bleeding were retrospectively reviewed. We evaluated the GBS, AIMS65 score, MAP score, Modified GBS, and Iino score, and assessed the outcomes of patients requiring hemostatic treatments at the subsequent emergency endoscopy. We performed logistic regression analysis of factors related to endoscopic hemostasis and upper gastrointestinal bleeding, created a new score model, and evaluated the prediction of hemostatic treatment and mortality in the new score and the existing scores.ResultsThe factors associated with endoscopic treatment were hematemesis, heart rate, HB (hemoglobin), blood pressure, blood urea nitrogen (BUN). Based on these predictors and the partial regression coefficients, a new score named H3B2 (using the initial letters of hematemesis, heart rate, HB, blood pressure, and BUN) was generated. H3B2 score was slightly more discriminatory compared to GBS and Modified GBS (area under the receiver operating characteristic curves (AUROC): 0.73 versus 0.721 and 0.7128, respectively) in predicting hemostatic treatment in emergency endoscopy. The H3B2 score also showed satisfactory prediction accuracy for subsequent deaths (AUROC: 0.6857. P ConclusionsWe proposed a new score, the H3B2 score, consisting of simple and objective indices in cases of suspected upper gastrointestinal bleeding. The H3B2 score is useful in identifying high-risk patients with suspected upper gastrointestinal bleeding who require urgent hemostatic treatment including emergency endoscopy.

BackgroundGastric metastasis from osteosarcoma is very rare and its clinical features are not well recognized.Case presentationA 73-year-old man was diagnosed with osteosarcoma and treated with four cycles of preoperative chemotherapy with ifosfamide and doxorubicin followed by wide resection. Two cycles of postoperative chemotherapy with ifosfamide and doxorubicin and ten cycles of chemotherapy with carboplatin and etoposide were administered. Eleven months after the surgery, he vomited fresh blood. Unusual progression of anemia was observed with the hematemesis. A biopsy was performed by gastrointestinal endoscopy, and the stomach tumor was diagnosed as metastasis of osteosarcoma.ConclusionsEven though gastric metastasis from osteosarcoma is very rare, all three previous reports and our case showed the presence of ulcer on the surface of the gastric lesion. We should consider the possibility of gastric metastasis in patients with osteosarcoma in whom progression of anemia or gastric hemorrhage is observed.

RationaleHematemesis is a common symptom of gastrointestinal disorders and is often associated with upper gastrointestinal issues. However, lingual thyroid, a rare ectopic thyroid condition, can also present with hematemesis, complicating diagnosis and increasing the risk of misdiagnosis. This paper reports a case of lingual thyroid in which the primary symptom was hematemesis.Patient concernsA 59-year-old male patient with dwarfism and congenital hypothyroidism underwent irregular thyroid hormone therapy. He was admitted to the hospital after experiencing hemoptysis and a sensation of a foreign body in the throat.DiagnosesEctopic lingual thyroid with nodular goiter and hemorrhage.InterventionsThe patient received medical management to control bleeding and was administered a daily regimen of levothyroxine sodium (100 µg).OutcomesDuring the follow-up period, the patient did not vomit blood.LessonsIn this case, the patient's initial presentation of hematemesis prompted clinicians to expand the diagnostic approaches after excluding common gastrointestinal etiologies, including rare conditions such as ectopic thyroid hemorrhage. Nodular lesions in ectopic thyroid tissue, characterized by abundant blood supply and superficial location, suggest that bleeding mechanisms may involve internal vascular rupture or ulcer formation. Endoscopic observation of an active hemorrhage strongly supports this pathological mechanism. The successful management of this case highlights the critical value of multidisciplinary collaboration for challenging rare diseases. Through the multidisciplinary team, we effectively integrated initial screening via endoscopic examination, precise localization through imaging modalities, and specialized decision-making from endocrinology and surgery departments. This comprehensive approach enables rapid diagnosis, formulates personalized conservative treatment plans, minimizes therapeutic risks, and ultimately achieves favorable patient outcomes.