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A case of recurrent gastrointestinal bleeding and protein-losing gastroenteropathy

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 288–293 (2007)Cite this article

Abstract

Background A 40-year-old male with pentalogy of Fallot (a congenital heart defect with five anatomical components) presented with recurrent gastrointestinal bleeding. He had recently recovered from a heart operation, which was performed to reconstruct the right ventricular outflow tract.

Investigations Laboratory tests and absorption tests, esophagogastroduodenoscopy, capsule endoscopy, human serum albumin scintigraphy, lymphoscintigraphy, CT and abdominal lymph-node histology.

Diagnosis Intestinal lymphangiectasia with concurrent protein-losing gastroenteropathy and recurrent gastrointestinal bleeding.

Management Despite a low-fat diet and surgical suturing of multiple small-bowel ulcerations the gastrointestinal bleeding continued. Serum albumin levels remained very low and severe lymphedema occurred. Unfortunately, the patient developed severe sepsis and died of multiple organ failure.

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Figure 1: Endoscopic image of a 40-year-old male with intestinal lymphangiectasia, concurrent protein-losing gastroenteropathy and recurrent gastrointestinal bleeding
Figure 2: Histologic image from a jejunal biopsy from the case patient
Figure 3: 99mTc-labeled human serum albumin scintigraphy images for the case patient: (A) 1 h and 15 min postinjection, (B) 1 h and 30 min postinjection, (C) 1 h and 45 min postinjection and (D) 3 h postinjection
Figure 4: Lymphoscintigraphic image using 99mTc-labeled nanocolloid for the case patient

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Authors and Affiliations

  1. H Herfarth is Associate Professor of Medicine at the University of North Carolina, NC, USA.,

    Hans Herfarth

  2. F Hofstädter is Head of the Department of Pathology, S Feuerbach is Head of the Department of Radiology, HJ Schlitt is Head of the Department of Surgery, J Schölmerich is Head of the Department of Internal Medicine I, and Head of the Gastroenterological Unit at the Department of Internal Medicine I at the University of Regensburg, and G Rogler is Professor of Gastroenterology, Regensburg, Germany.,

    Ferdinand Hofstädter, Stefan Feuerbach, Hans Jürgen Schlitt, Jürgen Schölmerich & Gerhard Rogler

Authors
  1. Hans Herfarth
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  2. Ferdinand Hofstädter
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  3. Stefan Feuerbach
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  4. Hans Jürgen Schlitt
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  5. Jürgen Schölmerich
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  6. Gerhard Rogler
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Correspondence to Hans Herfarth.

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The authors declare no competing financial interests.

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Herfarth, H., Hofstädter, F., Feuerbach, S. et al. A case of recurrent gastrointestinal bleeding and protein-losing gastroenteropathy. Nat Rev Gastroenterol Hepatol 4, 288–293 (2007). https://doi.org/10.1038/ncpgasthep0812

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