Intramural hematomas of the gastrointestinal system: a 5-year single center experience

PURPOSE: Although spontaneous intramural hematomas of the gastrointestinal tract are very rare, they may be observed with the use of oral anticoagulant, though less frequently in cases of hematological malignancy and other bleeding disorders. Cases diagnosed as spontaneous intramural hematoma have been assessed in our clinic. METHODS: The cases, which were diagnosed as spontaneous intramural hematoma in the gastrointestinal tract (SIHGT) following anamnesis, physical examination, biochemical, radiological and endoscopic findings from July 2008 to July 2012, have been assessed retrospectively. RESULTS: Seven out of 13 cases were women and the mean age was 65.1 years (34 to 82 years). The most frequent complaint on admission was abdominal pain. The most frequent location of SIHGT was the ileum (n = 8). Oral anticoagulant use was the most common cause of etiology (n = 12). In 10 cases, International normalized ratio values were higher than treatment range (2 to 3, where mechanical valve replacement was 2.5 to 3.5) and mean value was 7.6 (1.70 to 23.13). While 12 cases were discharged without problems with medical treatment, one case with acute myeloid leukemia died in the intensive care unit following cerebrovascular attack. CONCLUSION: Spontaneus bleeding and hematomas that may arise in connection with bleeding diathesis may be fatal in cases with long-term oral anticoagulant treatment and insufficient follow-up. In management of these cases, it may be necessary to arrange conservative follow up and/or initialize low molecular weight heparin, and administer vitamin K as well as replace blood products and coagulation factors when indicated

Immunohistochemical testing for <it>Helicobacter Pylori</it> existence in neoplasms of the colon

<p>Abstract</p> <p>Background</p> <p><it>Helicobacter pylori</it> is a common pathogen, and its prevalence varies with socioeconomic conditions (10–80%). It has recently been recognized as a class I carcinogen in relation to gastric cancer. The aim of this study was to investigate the presence of <it>Helicobacter pylori</it> in neoplasms of the colon by immunohistochemical methods.</p> <p>Methods</p> <p>The polypectomy materials of 51 patients (19 male and 32 female) who had undergone colonoscopic polypectomy were retrieved for retrospective examination. The endoscopic size and colonic localization of the polyps were recorded. Hematoxylin and eosin stains were evaluated according to histological type and grade of dysplasia. Biopsy stains were immunohistochemically treated with <it>Helicobacter pylori</it> antibodies by the streptavidine-biotin immunoperoxidase technique. <it>Helicobacter pylori</it> staining in the gastric mucosa was used as the control for the immunohistochemical method. Specimens were classified according to the presence of <it>Helicobacter pylori</it> under an optical microscope, and <it>Helicobacter pylori</it> positive specimens were stratified according to the respective staining pattern.</p> <p>Results</p> <p>Mean age was 61.88 ± 10.62 (40–82) years. Polyp sizes were 1.45 ± 0.92 (1–4) cm; and 25.5% of polyps were localized in the right colon, 68.6% in the left colon and 5.9% in the transverse colon. Presence of <it>Helicobacter pylori</it> was not correlated with localization (p > 0.05) or size of the polyps (p > 0.05).</p> <p>Eleven (21.6%) of all specimens included in the study were <it>Helicobacter pylori</it> positive by immunohistochemical methods. Of the <it>Helicobacter pylori</it> positive specimens, the staining pattern was diffuse: Equivocal in 90.9%, nonspecific with a finely granular type concentrated on the luminal surface in 90.9%, dot-like granular in 54.5%, and spiral in 9.1%. Of the tubular polyps, 17.9% were <it>H. pylori</it> positive, and the staining pattern was equivocal in 100%, luminal in 85.7%, and dot-like granular in 57.1%. Of the villous polyps, 60% were <it>H. pylori</it> positive, and the staining pattern was inconclusive in 66.7%, luminal in 100%, dot-like granular in 33.3%, and spiral in 33.3%. Of the cancerous cases, 25% were <it>H. pylori</it> positive and showed an equivocal, luminal, and dot-like granular staining pattern. No significant correlation was determined between histologic types and prevalence of <it>H. pylori</it> (p > 0.05).</p> <p>Conclusion</p> <p>The presence of <it>H. pylori</it> in colon polyps did not yield any correlation with polyp size, colonic localization or histopathologic type. The higher rate of <it>H. pylori</it> positivity in villous polyps does not present a causal relationship. We were able to determine <it>H. pylori</it> existence in colon polyps by immunohistochemical methods, albeit with no statistical significance.</p