[A patient with repeated, life-threatening gastro-intestinal haemorrhages treated by means of medication, open surgery, endoscopic surgery, intervention radiology and conservative methods].
A 56-year-old man with Henoch Schönlein purpura vasculitis suffered from repeated and multiple life-threatening gastrointestinal haemorrhages. Over recent years a number of interventions for the treatment of gastrointestinal haemorrhaging have become available; choosing which option to use can present difficulties. The available interventions are carried out by different disciplines and include haemostatic drugs, endoscopic intervention, intervention radiology, and surgery. In this patient, following a severe drop in haemoglobin levels, CT and angiography revealed active bleeding in the distal jejunum. Transarterial embolization by means of a coiling procedure halted the bleeding. The patient was also given tranexamic acid, a fibrinolysis inhibitor. More episodes of bleeding subsequently followed which necessitated further coiling procedures, two bowel resections, the endoscopic clipping of a bleeding artery, treatment with the recombinant activated factor VII (rFVIIa) at a dosage of 90 microg/kg, as well as conservative treatment with multiple transfusions of filtered erythrocytes and fresh plasma. The patient eventually recovered.
Academisch Medisch Centrum/Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam.
A P J
AP
Vlaar
E J
EJ
van Soest
M
M
Levi
K P
KP
van Lienden
M
M
Boermeester
E
E
de Jonge
D001803:Blood Transfusion; D015942:Factor VIIa / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications*; D007579:Jejunal Diseases / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D016896:Treatment Outcome
D011994:Recombinant Proteins; D015942:Factor VIIa