- Email: [email protected]
Gastrointestinal Bleeding Caused by a Penetrating Aortic Ulcer
Accepted Manuscript Gastrointestinal Bleeding Caused by a Penetrating Aortic Ulcer Samuel Raimundo Fernandes, MD, Carlos Noronha Ferreira, MD, José Velosa, MD, PhD
PII: DOI: Reference:
S1542-3565(17)30191-X 10.1016/j.cgh.2017.02.012 YJCGH 55113
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 13 February 2017 Please cite this article as: Fernandes SR, Noronha Ferreira C, Velosa J, Gastrointestinal Bleeding Caused by a Penetrating Aortic Ulcer, Clinical Gastroenterology and Hepatology (2017), doi: 10.1016/ j.cgh.2017.02.012. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Gastrointestinal Bleeding Caused by a Penetrating Aortic Ulcer Authors:
1. Samuel Raimundo Fernandes, MD – Corresponding author
Hospitalar Lisboa Norte. Avenida Egas Moniz, Lisboa 1649-035 Email: [email protected]
SC
2. Carlos Noronha Ferreira, MD
RI PT
Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro
Hospitalar
M AN U
Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro
Lisboa Norte. Avenida Egas Moniz, Lisboa 1649-035 Email: [email protected]
3. José Velosa, MD, PhD
Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro
TE D
Hospitalar Lisboa Norte
EP
Email: [email protected]
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The manuscript, including related data, figures and tables have not been previously published and are not under consideration for publication elsewhere. Patient informed consent was obtained for this paper. The authors have no conflicts of interest to declare.
Correspondence to: Samuel R. Fernandes Rua Fernando Namora nº 24, 5ºC 2675-487 Odivelas, Portugal. Telephone: +351968644836
ACCEPTED MANUSCRIPT A 78-year-old man with primary hypertension, dyslipidemia and cerebrovascular disease presented with severe gastrointestinal bleeding. His medication included low-dose aspirin (100 mg/day). Twenty-four hours prior to admission, he started complaining of intense back pain unrelieved by ibuprofen. He later developed hematemesis with syncope and was admitted to our intensive care
RI PT
unit for resuscitation. Initial blood tests showed normocytic anemia [hemoglobin 8.0 g/dl (13.0-17.5)], mild leukocytosis [12.2 (4.0-11.0)], and normal platelets [276 (150-450)], and prothrombin time [13.9 (<11.6)]. Upper gastrointestinal endoscopy revealed an ulcerated lesion with a fresh cloth bulging in the
SC
proximal esophagus (Figure A). Emergency CT revealed diffuse atherosclerotic disease with irregular thickening of the descending aorta and a large intramural hematoma between the aorta and the esophagus (Figure B). These findings
M AN U
were compatible with a penetrating aortic ulcer (PAU) with dissection of the aorta. The patient underwent successful endovascular repair and was discharged one week later. PAUs are believed to originate from progressive erosion of atheromatous mural plaques (1). Hypertension and dyslipidemia are predisposing factors explaining why this situation is more common in older
and rupture (3).
TE D
patients (2). Coexistence with aortic dissection increases the risk of expansion
EP
1. Wada H, Sakata N, Tashiro T. Clinicopathological study on penetrating atherosclerotic ulcers and aortic dissection: distinct pattern of development of
AC C
initial event. Heart Vessels. 2016 Nov;31:1855-1861.
2. Reed D, Reed C, Stemmermann G, et al. Are aortic aneurysms caused by atherosclerosis? Circulation. 1992 Jan;85(1):205-11
3.Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of
ACCEPTED MANUSCRIPT
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EP
TE D
M AN U
SC
RI PT
Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Catheter Cardiovasc Interv. 2010 Aug 1;76(2):E43-86.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
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EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
PII: DOI: Reference:
S1542-3565(17)30191-X 10.1016/j.cgh.2017.02.012 YJCGH 55113
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 13 February 2017 Please cite this article as: Fernandes SR, Noronha Ferreira C, Velosa J, Gastrointestinal Bleeding Caused by a Penetrating Aortic Ulcer, Clinical Gastroenterology and Hepatology (2017), doi: 10.1016/ j.cgh.2017.02.012. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Gastrointestinal Bleeding Caused by a Penetrating Aortic Ulcer Authors:
1. Samuel Raimundo Fernandes, MD – Corresponding author
Hospitalar Lisboa Norte. Avenida Egas Moniz, Lisboa 1649-035 Email: [email protected]
SC
2. Carlos Noronha Ferreira, MD
RI PT
Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro
Hospitalar
M AN U
Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro
Lisboa Norte. Avenida Egas Moniz, Lisboa 1649-035 Email: [email protected]
3. José Velosa, MD, PhD
Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro
TE D
Hospitalar Lisboa Norte
EP
Email: [email protected]
AC C
The manuscript, including related data, figures and tables have not been previously published and are not under consideration for publication elsewhere. Patient informed consent was obtained for this paper. The authors have no conflicts of interest to declare.
Correspondence to: Samuel R. Fernandes Rua Fernando Namora nº 24, 5ºC 2675-487 Odivelas, Portugal. Telephone: +351968644836
ACCEPTED MANUSCRIPT A 78-year-old man with primary hypertension, dyslipidemia and cerebrovascular disease presented with severe gastrointestinal bleeding. His medication included low-dose aspirin (100 mg/day). Twenty-four hours prior to admission, he started complaining of intense back pain unrelieved by ibuprofen. He later developed hematemesis with syncope and was admitted to our intensive care
RI PT
unit for resuscitation. Initial blood tests showed normocytic anemia [hemoglobin 8.0 g/dl (13.0-17.5)], mild leukocytosis [12.2 (4.0-11.0)], and normal platelets [276 (150-450)], and prothrombin time [13.9 (<11.6)]. Upper gastrointestinal endoscopy revealed an ulcerated lesion with a fresh cloth bulging in the
SC
proximal esophagus (Figure A). Emergency CT revealed diffuse atherosclerotic disease with irregular thickening of the descending aorta and a large intramural hematoma between the aorta and the esophagus (Figure B). These findings
M AN U
were compatible with a penetrating aortic ulcer (PAU) with dissection of the aorta. The patient underwent successful endovascular repair and was discharged one week later. PAUs are believed to originate from progressive erosion of atheromatous mural plaques (1). Hypertension and dyslipidemia are predisposing factors explaining why this situation is more common in older
and rupture (3).
TE D
patients (2). Coexistence with aortic dissection increases the risk of expansion
EP
1. Wada H, Sakata N, Tashiro T. Clinicopathological study on penetrating atherosclerotic ulcers and aortic dissection: distinct pattern of development of
AC C
initial event. Heart Vessels. 2016 Nov;31:1855-1861.
2. Reed D, Reed C, Stemmermann G, et al. Are aortic aneurysms caused by atherosclerosis? Circulation. 1992 Jan;85(1):205-11
3.Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Catheter Cardiovasc Interv. 2010 Aug 1;76(2):E43-86.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT