| Title: |
A STITCH IN TIME SAVES NINE: A CASE REPORT ON THE COMPLICATIONS OF UNTREATED GASTROINTESTINAL BLEEDING. |
| Authors: |
Pasca, Adnana1, Rusu, Andrei1, Grama, Paul1, Ciorbă, Ilie Marius1 |
| Source: |
Acta Marisiensis. Seria Medica. 2024 Supplement, Vol. 70, p191-192. 2p. |
| Subject Terms: |
*GASTROINTESTINAL hemorrhage treatment, *HEMOSTATICS, *GASTROINTESTINAL hemorrhage, *NASOENTERAL tubes, *PEPTIC ulcer, *SYNCOPE, *HEMOGLOBINS, *HERNIA, *HYALURONIC acid, *IMMUNOGLOBULINS, *DUODENAL ulcers, *AMOXICILLIN, *CONFERENCES & conventions, *CHONDROITIN sulfates, *QUINOLONE antibacterial agents, *UREA, *ENDOSCOPIC gastrointestinal surgery, *GASTRITIS, *HELICOBACTER diseases, *PANTOPRAZOLE, *BLOOD transfusion, *RECTUM |
| Geographic Terms: |
ROMANIA |
| Abstract: |
Introduction: Upper gastrointestinal bleeding defines blood loss from the gastrointestinal tract, situated above the ligament of Treitz. Presenting symptoms may include hematemesis, melena or hematochezia. Weakness, fatigue, orthostatic hypotension or syncope can also be associated due to potential severe blood loss. Risk factors include anticoagulant use, high doses of nonsteroidal anti-inflammatory drug use, active Helicobacter pylori infection, gastritis and peptic ulcers. Case Report: Our case: 43 years old male, with a recent history of peptic ulcer under treatment, presented in the emergency department accusing melena (starting 5 days prior to consultation) and syncope. Paraclinical investigations: Hb 7.2 g/dl (severe secondary anemia), urea 64 mg/dl. Through the nasogastric tube stasis liquid was evacuated, while rectal examination was positive for melena. Upper gastroesophageal endoscopy disclosed the presence of erosive gastritis, posterior-bulbar duodenal ulcer (Forrest 2A class) and sliding hiatal hernia. The patient was admitted to the Gastroenterology Department and received the following treatment: Pantoprazole, Carbazocrome and Etamsylate. During the hospitalization the patient received 2 units of transfusion blood, that progressively ameliorated his general status. Since the ulcer was endoscopically described as non-bleeding, but with a visible vessel, multiple attempts in clamping the hemorrhage source were performed, but without success due to the difficult position. The medical treatment initiated consisted of Pantoprazole, chondroitin sulfate and hyaluronic acid for the gastric protection, and Amoxicillin, Levofloxacin and bismuth oxide for the H. Pylori infection, that was revealed by high serum IgG levels. Discussions : The erosive gastritis and the infection with H. Pylori are the main causes of the peptic ulcer, that may lead to gastrointestinal bleeding. The loss of blood and the severe secondary anemia culminated into an episode of syncope and therefore, when investigating such a hemorrhage, identifying its precise location is of great importance. The Forrest classification is used to predict the risk of further bleeding and to guide the gastroenterologist in finding the right approach, in particular if they should use endoscopic therapy. Current guidelines recommend this specific technique for ulcers with active spurting/oozing and for those with nonbleeding visible vessels (the case of our patient). Eradicating the bacterial infection is also essential for avoiding recurring episodes. Conclusions: Considering the potential complications of gastrointestinal bleeding, endoscopic exploration can be the key in finding the source of the hemorrhage. High volumes of blood can be lost, leading to severe hemodynamic effects. Not only the bleeding should receive treatment, but also the underlying pathology must be targeted. [ABSTRACT FROM AUTHOR] |
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