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Rare Cause of Upper Gastrointestinal Bleeding Vipul D. Yagnik
Department of Surgery, Pramukhswami Medical College, Karamsad - 388 325, Gujarat, India Address for correspondence: Dr. Vipul Yagnik, 77, Siddhraj Nagar, Rajmahal Road, Patan-384265, Gujarat, India. E-mail:
[email protected] PubMed ID: **** DOI: 10.4103/1319-3767.70635
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An elderly male presented to the emergency department with compliant of blood in the vomitus and passing black colored stool since last 1 day. He had a known history of ischemic heart disease and left medical treatment two years back.. He was allergic to aspirin. There was no history of alcohol abuse or NSAID use. His ECHO report showed 50% ejection fraction. On examination, he was having tachycardia and hypotension. Blood chemistry revealed hemoglobin of 6 g%, rest of the blood investigations were normal. USG abdomen was normal. Upper GI endoscopy revealed a lesion in the stomach [Figure 1].
QUESTIONS Q1. What is the diagnosis? Q2. Which is the most effective treatment to control bleeding from this condition? Q3. What percentage of patients re-bleed?
Figure 1: Lesion in the stomach
The Saudi Journal of Gastroenterology
319 Volume 16, Number 4 Shawwal 1431 H October 2010
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ANSWERS
A.3. 11-15%. Most cases of rebleeding can be effectively controlled by repeat endoscopic therapy.[2]
A1. Dieulafoy’s lesion is an uncommon cause for upper GI bleeding. Common site for this lesion is near the Gastroesophageal junction lesion. Incidence is 2-5%[1] of upper GI bleeding. The symptoms are either of hematemesis or melena. Upper GI endoscopy helps in diagnosis as well as treatment. A2. Contact thermal ablation with heater probe with or without adrenalin injection.
REFERENCES 1.
2.
Larson G, Schmidt T, Gott J, Bond S, O’Connor CA, Richardson JD. Upper gastrointestinal bleeding: Predictors of outcome. Surgery 1986;100:765-73. Reilly HF 3rd, al-Kawas FH. Dieulafoy’s lesion: Diagnosis and management. Dig Dis Sci 1991;36:1702-7. Source of Support: Nil, Conflict of Interest: None declared.
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320 Volume 16, Number 4 Shawwal 1431 H October 2010
The Saudi Journal of Gastroenterology
