https://doi.org/10.4081/ecj.2023.11540

A case of hemorrhagic shock due to massive upper gastrointestinal bleeding: from the differential diagnosis to the correct management

Vol. 19 No. 3 (2023)
Submitted: 24 June 2023
Accepted: 13 August 2023
Published: 8 September 2023
Acute gastrointestinal bleeding, shock, haemorrhagic, endoscopy, CT scan, resuscitation
Abstract Views: 1010
PDF: 434
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Authors

Beatrice Marziani
Department of Translational Medicine, University of Ferrara, Ferrara; School of Emergency Medicine, University of Ferrara, Ferrara, Italy.
Michele Domenico Spampinato
spmmhl@unife.it
https://orcid.org/0000-0002-2285-327X
Department of Translational Medicine, University of Ferrara, Ferrara; School of Emergency Medicine, University of Ferrara, Ferrara, Italy.
Fabio Caputo
Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Matteo Guarino
https://orcid.org/0000-0001-5841-8555
Department of Translational Medicine, University of Ferrara, Ferrara; School of Emergency Medicine, University of Ferrara, Ferrara, Italy.
Francesco Luppi
https://orcid.org/0009-0006-9209-3727
Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Benedetta Perna
Department of Translational Medicine, University of Ferrara, Ferrara; School of Emergency Medicine, University of Ferrara, Ferrara, Italy.
Angelina Passaro
https://orcid.org/0000-0001-8462-7000
Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Daniele Cariani
https://orcid.org/0009-0001-7978-3903
Emergency Medicine Unit, Department of Emergency Medicine, St. Anna University Hospital, Ferrara, Italy.
Alberto Merighi
https://orcid.org/0000-0002-8642-9072
Gastroenterology Unit, Arcispedale S. Anna, Ferrara, Italy.
Rosario Arena
Gastroenterology Unit, Arcispedale S. Anna, Ferrara, Italy.
Roberto De Giorgio
https://orcid.org/0000-0003-0867-5873
Department of Translational Medicine, University of Ferrara, Ferrara; School of Emergency Medicine, University of Ferrara, Ferrara, Italy.

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.

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Beatrice Marziani, Department of Translational Medicine, University of Ferrara, Ferrara; School of Emergency Medicine, University of Ferrara, Ferrara

 

 

Fabio Caputo, Department of Translational Medicine, University of Ferrara, Ferrara

 

 

Matteo Guarino, Department of Translational Medicine, University of Ferrara, Ferrara; School of Emergency Medicine, University of Ferrara, Ferrara

 

 

Francesco Luppi, Department of Translational Medicine, University of Ferrara, Ferrara

 

 

Benedetta Perna, Department of Translational Medicine, University of Ferrara, Ferrara; School of Emergency Medicine, University of Ferrara, Ferrara

 

 

Angelina Passaro, Department of Translational Medicine, University of Ferrara, Ferrara

 

 

Daniele Cariani, Emergency Medicine Unit, Department of Emergency Medicine, St. Anna University Hospital, Ferrara

 

 

Alberto Merighi, Gastroenterology Unit, Arcispedale S. Anna, Ferrara

 

 

Rosario Arena, Gastroenterology Unit, Arcispedale S. Anna, Ferrara

 

 

Roberto De Giorgio, Department of Translational Medicine, University of Ferrara, Ferrara; School of Emergency Medicine, University of Ferrara, Ferrara

 

 

How to Cite

Marziani, B., Spampinato, M. D., Caputo, F., Guarino, M., Luppi, F., Perna, B., Passaro, A., Cariani, D., Merighi, A., Arena, R., & De Giorgio, R. (2023). A case of hemorrhagic shock due to massive upper gastrointestinal bleeding: from the differential diagnosis to the correct management. Emergency Care Journal, 19(3). https://doi.org/10.4081/ecj.2023.11540
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