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一例看似上消化道出血病例中意外“访客”的全身症状,最终通过内镜取出异物:病例报告

Systemic Signs of an Unexpected Guest in a Case of Apparent Upper Gastrointestinal Bleeding Leading to an Endoscopic Extraction of a Foreign Body: A Case Report.

作者信息

Crăciun Rareș, Tefas Cristian

机构信息

Department of Internal Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania.

Department of Gastroenterology, "Prof. Dr. Octavian Fodor" Institute of Gastroenterology and Hepatology, 19-21 Croitorilor Street, 400162 Cluj-Napoca, Romania.

出版信息

Reports (MDPI). 2025 Feb 19;8(1):26. doi: 10.3390/reports8010026.


DOI:10.3390/reports8010026
PMID:40729239
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12199919/
Abstract

Upper gastrointestinal (GI) bleeding is a common emergency, typically requiring prompt intervention. This case report presents a unique situation where apparent GI bleeding was ultimately identified as anaphylaxis triggered by accidental wasp ingestion. Such cases are rare, underscoring the need for a broad differential diagnosis in atypical presentations. A 53-year-old male with a history of heavy alcohol use presented with presumed acute hematemesis, hypotension, and tachycardia. An initial examination revealed mild anemia and elevated liver enzymes. An urgent upper GI endoscopy showed severe esophagitis with no signs of active or stigmata of recent bleeding; instead, two dead wasps were found in the gastric antrum. Further inquiry revealed that the patient had recently consumed a home-brewed alcoholic beverage, likely contaminated with the wasps. The patient's symptoms were then attributed to anaphylaxis from venom exposure rather than hemorrhagic shock. The patient's condition improved with antihistaminic therapy, and he was discharged with follow-up recommendations. : This case highlights the importance of considering rare but critical diagnoses, such as insect-induced anaphylaxis, in patients presenting with presumed GI bleeding. It reinforces the value of thorough history taking, prompt endoscopy, and systematic management in assessing and treating atypical emergency presentations.

摘要

上消化道(GI)出血是一种常见的急症,通常需要迅速干预。本病例报告呈现了一种独特的情况,即明显的胃肠道出血最终被确定为由意外摄入黄蜂引发的过敏反应。此类病例罕见,凸显了在非典型表现中进行广泛鉴别诊断的必要性。一名有大量饮酒史的53岁男性,出现疑似急性呕血、低血压和心动过速症状。初步检查显示轻度贫血和肝酶升高。紧急上消化道内镜检查显示严重食管炎,无近期活动性出血或出血迹象;相反,在胃窦发现了两只死黄蜂。进一步询问得知,患者近期饮用了自酿酒精饮料,可能被黄蜂污染。患者的症状随后被归因于毒液暴露引起的过敏反应,而非失血性休克。患者经抗组胺治疗后病情好转,并在出院时得到随访建议。:本病例强调了在疑似胃肠道出血的患者中考虑罕见但关键的诊断(如昆虫诱发的过敏反应)的重要性。它强化了在评估和治疗非典型急症时详细病史采集、及时内镜检查和系统管理的价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e96a/12199919/d2bb0b4b2510/reports-08-00026-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e96a/12199919/e132eb03e4c5/reports-08-00026-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e96a/12199919/969f84558442/reports-08-00026-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e96a/12199919/d2bb0b4b2510/reports-08-00026-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e96a/12199919/e132eb03e4c5/reports-08-00026-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e96a/12199919/969f84558442/reports-08-00026-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e96a/12199919/d2bb0b4b2510/reports-08-00026-g003.jpg

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本文引用的文献

[1]
Occupational anaphylaxis: A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI).

Allergol Select. 2024-11-28

[2]
Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement.

Endoscopy. 2024-2

[3]
EAACI guidelines: Anaphylaxis (2021 update).

Allergy. 2022-2

[4]
Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021.

Endoscopy. 2021-3

[5]
Endoscopic treatment of variceal upper gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Cascade Guideline.

Endosc Int Open. 2020-7

[6]
EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy.

Allergy. 2017-12-5

[7]
Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

Endoscopy. 2016-5

[8]
A stinging wasp in the stomach: accidental endoscopic diagnosis of a systemic anaphylactic reaction.

Endoscopy. 2015

[9]
Anaphylaxis as occupational risk.

Curr Opin Allergy Clin Immunol. 2014-8

[10]
Unusual summertime foreign body in the esophagus.

Endoscopy. 1999-3

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