Report of a case involving novel use of a post-operative esophagogastroduodenoscopy to re-evaluate a duodenal ulcer bleed
| العنوان: | Report of a case involving novel use of a post-operative esophagogastroduodenoscopy to re-evaluate a duodenal ulcer bleed |
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| المؤلفون: | Sameh Shoukry, Ali Kimyaghalam, Rhett Fullmer, Azzan Arif, Robert DeVito, Matthew Simpson |
| المصدر: | International Journal of Surgery Case Reports |
| بيانات النشر: | Elsevier BV, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | medicine.medical_specialty, Duodenum, Exploratory laparotomy, medicine.medical_treatment, Perforation (oil well), Pyloroplasty, Gastroduodenostomy, 03 medical and health sciences, 0302 clinical medicine, Case report, Medicine, Ulcer, medicine.diagnostic_test, business.industry, Esophagogastroduodenoscopy, Bleeding, Endoscopy, Interventional radiology, Bleed, Surgery, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business, Repair |
| الوصف: | Highlights • Acute duodenal ulcer bleeds can be life-threatening. • The best initial management is by endoscopy or Interventional Radiology. • Emergency surgical intervention is indicated if unable to control. • Post-surgical endoscopy in an OR setting was used to re-evaluate. • May be a viable option for post-surgical re-evaluation in the absence of IR. Introduction Acute gastrointestinal (GI) bleeding can be a life-threatening condition. This is usually diagnosed and managed by an upper GI tract endoscopy. When treating actively bleeding duodenal ulcers, surgical intervention, or arterial embolization by Interventional Radiology (IR) is warranted in the event of failed initial management. We present a patient with a significant GI bleed and failure of management through endoscopy, necessitating emergent surgical intervention. Presentation of case An 87-year-old female presented to the emergency department after a fall. Her hemoglobin level dropped significantly and an esophagogastroduodenoscopy (EGD) revealed a large pool of blood in the stomach but had a limited view of an active bleed. The patient was taken emergently to the operating room (OR) where she underwent an exploratory laparotomy, gastroduodenostomy, suture ligation, and pyloroplasty. The following day, she had increased sanguineous output from her nasogastric (NG) tube. Re-evaluation was done with an EGD in the OR. The patient tolerated all procedures well and was transferred to a facility with IR capabilities for further management. Discussion An EGD hours after gastroduodenostomy runs a high risk for perforation and is not the typical course of action. Given the lack of IR availability and concern for rebleeding, this procedure was performed in the OR to minimize risk. Conclusion A favorable outcome was achieved with this patient and hemostasis was confirmed with the post-operative EGD. Further studies will determine whether this approach is a viable option for facilities without IR until the patient can be transferred. |
| تدمد: | 2210-2612 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b3004b472f32d8eaa9e20ac9ae070d38Test https://doi.org/10.1016/j.ijscr.2020.10.094Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....b3004b472f32d8eaa9e20ac9ae070d38 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 22102612 |
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