Description
A 78-year-old woman presented to her local accident and emergency department by ambulance, having collapsed following several episodes of voluminous fresh haematemesis with melaena. The patient had extensive medical comorbidities, suffering from type 2 diabetes mellitus, ischaemic heart disease, bronchiectasis and severe pulmonary hypertension. Three weeks previously she had undergone an uncomplicated total hip replacement for osteoarthritis and had been using non-steroidal anti-inflammatory drugs (NSAIDs) for analgesia. She had no history of gastroenterological disease.
The patient responded to initial resuscitative measures sufficiently to undergo oesophagogastroduodenoscopy. The gastroenterologist struggled to achieve any useful view of either stomach or duodenum due to the volume of haemorrhage, and aborted the procedure. The patient rapidly displayed signs of haemodynamic instability and deteriorated into a state of refractory hypovolaemic shock. She was intubated and ventilated.
The patient underwent laparotomy and antrotomy with duodenotomy, which showed no focal gastric or duodenal abnormality. Attempted...
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