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Digestive Diseases and Sciences

, Volume 63, Issue 4, pp 845–850 | Cite as

Exposé: Different Faces of a Bleeding Giant Duodenal Ulcer

  • George TriadafilopoulosEmail author
  • David Lewis
Stanford Multidisciplinary Seminars
  • 157 Downloads

Case Presentation and Evolution

A 78-year old woman was brought to the Emergency Department by paramedics because of hematemesis, melena, and severe hypotension. She had a background history of mild dementia, chronic alcoholism and compensated alcoholic cirrhosis, chronic iron deficiency anemia, chronic left foot neuropathic ulceration, seizure disorder, and a remote history of breast cancer, cerebrovascular accident, and fall-related pelvic fracture. There was no history of prior cigarette smoking, or peptic ulcer disease. At presentation, she was lethargic, hypotensive (BP = 84/40) and mildly tachycardic and tachypneic. Her hemoglobin was 9.8 mg/dl, but after initial fluid boluses, it dropped to 7.4 despite the transfusion of two units of blood. She reported no abdominal pain. Her heart and lung examination was normal; her abdomen was obese but soft without organomegaly. She did not have any stigmata of cirrhosis or ascites. Electrocardiogram and troponin levels suggested demand...

References

  1. 1.
    Ciociola AA, McSorley DJ, Turner K, Sykes D, Palmer JB. Helicobacter pylori infection rates in duodenal ulcer patients in the United States may be lower than previously estimated. Am J Gastroenterol. 1999;94:1834–1840.CrossRefPubMedGoogle Scholar
  2. 2.
    Wong GL, Wong VW, Chan Y, et al. High incidence of mortality and recurrent bleeding in patients with Helicobacter pylori-negative idiopathic bleeding ulcers. Gastroenterology. 2009;137:525–531.CrossRefPubMedGoogle Scholar
  3. 3.
    Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974;2:394–397.CrossRefPubMedGoogle Scholar
  4. 4.
    Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal hemorrhage. Gut. 1996;38:316–321.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Laine L. Upper gastrointestinal bleeding due to a peptic ulcer. N Engl J Med. 2016;374:2367–2376.CrossRefPubMedGoogle Scholar
  6. 6.
    Lee KE, Shim KN, Tae CH, et al. Multidisciplinary approach to refractory upper gastrointestinal bleeding: case series of angiographic embolization. J Korean Med Sci. 2017;32:1552–1557.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Park SJ, Park H, Lee YC, et al. Effect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial. Gastrointest Endosc. 2017. doi: 10.1016/j.gie.2017.07.024. [Epub ahead of print].
  8. 8.
    Chan, FKL, Lau JYW. Peptic ulcer disease. In: Sleisenger and Fordtran’s gastrointestinal and liver disease. Jan 1, 2016. pp. 884–900.e5. 2016.Google Scholar
  9. 9.
    Lee JL, Oh ES, Lee RW, Finucane TE. Serum albumin and prealbumin in calorically restricted, nondiseased Individuals: a systematic review. Am J Med. 2015;128:1023-e1.CrossRefGoogle Scholar
  10. 10.
    Cheng HC, Yang EH, Wu CT, et al. Hypoalbuminemia is a predictor of mortality and re-bleeding in peptic ulcer bleeding under proton pump inhibitor use. J Formos Med Assoc. 2017. doi: 10.1016/j.jfma.2017.07.006. [Epub ahead of print].
  11. 11.
    Ardevol A, Ibañez-Sanz G, Profitos J, et al.. Survival of patients with cirrhosis and acute peptic ulcer bleeding compared with variceal bleeding using current first-line therapies. Hepatology. 2017 Jul 17. doi: 10.1002/hep.29370. [Epub ahead of print].
  12. 12.
    Yoshida H, Onda M, Tajiri T, et al. A case of abscess caused by a penetrating duodenal ulcer. Hepato-gastroenterology. 1999;46:2379–2381.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Stanford Multidimensional Program for Innovation and Research in the Esophagus (S-MPIRE), Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordUSA
  2. 2.Internal MedicineEl Camino HospitalMountain ViewUSA

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