A case of hemorrhagic shock due to massive upper gastrointestinal bleeding: from the differential diagnosis to the correct management
https://doi.org/10.4081/ecj.2023.11540
Accepted: 13 August 2023
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Upper Gastro-Intestinal Bleeding (UGIB) spans from minor bleeding to life-threatening events. Identification of early signs of shock, proper management of hemodynamically unstable patients, and correct risk stratification are essential for an appropriate diagnostic workup and therapy. This case reports a young man admitted to the emergency department with haematemesis. His medical history was unremarkable, without any risk factors for gastrointestinal bleeding. A few hours after admission, further episodes of haematemesis occurred, and the patient's condition rapidly deteriorated to irreversible shock. A contrast-enhanced computed tomography (CECT) revealed morphological features of chronic liver disease and oesophagal varices. The patient underwent upper gastrointestinal endoscopy, confirming oesophagal varices with massive bleeding. Although promptly applied, endoscopic hemostasis was ineffective, and the patient died twenty-four hours after admission. Based on this case, we reviewed the diagnostic and therapeutic approaches for patients with massive UGIB and provided a practical approach to this life-threatening emergency.
Kelly CA, Upex A, Bateman DN. Comparison of consciousness level assessment in the poisoned patient using the alert/verbal/painful/unresponsive scale and the Glasgow Coma Scale. Ann Emerg Med 2004;44:108-13. DOI: https://doi.org/10.1016/j.annemergmed.2004.03.028
Chen IC, Hung MS, Chiu TF, et al. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med 2007;25:774-9. DOI: https://doi.org/10.1016/j.ajem.2006.12.024
Peery AF, Crockett SD, Murphy CC, et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2018. Gastroenterology 2019;156:254–72.e11. DOI: https://doi.org/10.1053/j.gastro.2018.08.063
Wuerth BA, Rockey DC. Changing Epidemiology of Upper Gastrointestinal Hemorrhage in the Last Decade: A Nationwide Analysis. Dig Dis Sci 2018;63:1286-1293. DOI: https://doi.org/10.1007/s10620-017-4882-6
Tielleman T, Bujanda D, Cryer B. Epidemiology and risk factors for upper gastrointestinal bleeding. Gastrointest Endosc Clin N Am 2015;25:415-428. DOI: https://doi.org/10.1016/j.giec.2015.02.010
Wu LM, Xu JR, Yin Y, Qu XH. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding: a meta-analysis. World J Gastroenterol 2010;16:3957-63. DOI: https://doi.org/10.3748/wjg.v16.i31.3957
García-Blázquez V, Vicente-Bártulos A, Olavarria-Delgado A, et al. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol 2013;23:1181-90. DOI: https://doi.org/10.1007/s00330-012-2721-x
Kamboj AK, Hoversten P, Leggett CL. Upper gastrointestinal bleeding: aetiologies and management. Mayo Clin Proc 2019;94:697-703. DOI: https://doi.org/10.1016/j.mayocp.2019.01.022
Wells ML, Hansel SL, Bruining DH, et al. CT for evaluation of acute gastrointestinal bleeding. Radiographics 2018;38:1089-1107. DOI: https://doi.org/10.1148/rg.2018170138
Saltzman, JR. Approach to acute upper gastrointestinal bleeding in adults. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2023.
Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol 2021;116:899–917. DOI: https://doi.org/10.14309/ajg.0000000000001245
Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol 2012;107:345–60. DOI: https://doi.org/10.1038/ajg.2011.480
Laursen SB, Leontiadis GI, Stanley AJ, et al. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study. Gastrointest Endosc 2017;85:936–44 e3. DOI: https://doi.org/10.1016/j.gie.2016.08.049
Lau JYW, Yu Y, Tang RSY, et al. Timing of endoscopy for acute upper gastrointestinal bleeding. N Engl J Med 2020;382:1299–308. DOI: https://doi.org/10.1056/NEJMoa1912484
Herrera JL. Management of acute variceal bleeding. Clin Liver Dis 2014;18:347-57. DOI: https://doi.org/10.1016/j.cld.2014.01.001
D'Amore K, Swaminathan A. Massive Gastrointestinal Hemorrhage. Emerg Med Clin North Am 2020;38:871-889. DOI: https://doi.org/10.1016/j.emc.2020.06.008
ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group. Advanced trauma life support (ATLS®)10th Edition Student Course Manual.
Sommer N, Schnüriger B, Candinas D, et al. Massive transfusion protocols in nontrauma patients: A systematic review and meta-analysis. J Trauma Acute Care Surg 2019;86:493-504. DOI: https://doi.org/10.1097/TA.0000000000002101
Issa D, Solomon S, Hillyard J, et al. Azithromycin versus erythromycin infusions prior to endoscopy in upper gastrointestinal bleeding. Transl Gastroenterol Hepatol 2022;7:35. DOI: https://doi.org/10.21037/tgh-20-51
Serra S, Spampinato MD, Riccardi A, et al. Pain management at the end of life in the emergency department: a narrative review of the literature and a practical clinical approach. J Clin Med 2023;12:4357. DOI: https://doi.org/10.3390/jcm12134357
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