A rare cause of upper GI bleeding in a critically ill patient

See page 1438 for question Clinical presentation A 60-year-old woman presented with melaena at the intensive care unit 21 days after a complicated coronary artery bypass surgery with intraoperative cardiopulmonary resuscitation. The postoperative course was complicated by prolonged ventilator support and wound infections without signs of severe sepsis or multiorgan failure. She was haemodynamically stable with no significant drop in haemoglobin. Physical examination did not reveal abdominal tenderness, skin or mucosal lesions. Laboratory tests showed mild anaemia (92 g/l; normal range 120–180 g/l) and mild thrombocytopenia (114 x 10*9/l, normal range 140–400 x 10*9/l), and clotting time was unremarkable. Prophylactic anticoagulation was administered. Her medical history included arterial hypertension, peripheral artery disease and nicotine abuse. There was no prehospital diagnosis of immunosuppression. Oesophagogastroduodenoscopy performed the next day demonstrated a diffusely ulcerated oesophagus from upper oesophageal sphincter to gastro-oesophageal junction with active oozing bleeding. Some ulcers penetrated the muscle layers (figure 1A). Stomach and...
Source: Gut - Category: Gastroenterology Authors: Tags: GUT Snapshot Editor ' s quiz: GI snapshot Source Type: research