Bibliographic record
Abstract
A 68 year-old female is referred to the Gastroenterology consultation service from the Emergency Department (ED) for brisk gastrointestinal bleeding. Five months prior, she was admitted for multiple intra-abdominal abscesses from perforated appendix, requiring right hemicolectomy and small bowel resection. She was also known for deep vein thrombosis on low-molecular-weight heparin and ovarian cancer considered in remission. Case report and review of the literature See above She presented to the Royal Victoria Hospital for witnessed syncope and significant hematochezia of acute onset. She was profoundly hypotensive, requiring aggressive fluid resuscitation. Her physical exam showed mild epigastric and right lower quadrant pain, as well as bright red blood on the digital rectal examination. Her initial hemoglobin of 80 dropped to 32, with ongoing hematochezia. Nasogastric tube insertion was unsuccessful. A gastroscopy showed normal mucosa with no blood seen up to the distal duodenum. Overnight, she suffered from a recurrent episode of brisk hematochezia, requiring the activation of a massive transfusion protocol. Given her ongoing blood loss, she was sent for a mesenteric angiogram which identified an actively-bleeding fistula from the right external iliac artery to the transverse colon. The interventional radiologist decided to deploy a balloon-assisted covered stent to close off the fistula. Immediately after deployment, the patient’s hemodynamics improved. The vascular surgery team decided against operative management in view of a suspected low operative success from multiple prior surgeries and radiation therapy. Asymptomatic, she was discharged eleven days after her presentation. This rare case highlights the importance of early recognition of life-threatening conditions, such as arterioenteric fistulas (AEF). It also illustrates a rare mechanism of fistula formation. Most cases of AEFs are described as secondary, namely as a complication of prior aortic reconstruction. Approximately 250 cases of primary AEF have been reported in the published literature, of which only 15% affected the colon. In our patient’s case, the main risk factors for primary AEF were encasing peri-iliac abscesses, subsequent bowel manipulation and prior radiation therapy. Prompt investigation is a key component of AEF prognosis. Angiography permits direct AEF visualization and potential placement of a covered stent graft, either as a bridge to open surgery or as a definitive therapy for patients with high operative risk. However, stent placement harbours significant rebleeding rates and infectious complications. Optimal management in these cases remains controversial, such as the use of prophylactic antibiotics or serial imaging. Even though high-quality evidence is scarce, angiography with endovascular intervention is considered first-line treatment in patients with hemodynamic instability. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".