title: Improving outcome following life-threatening gastrointestinal bleeding not amenable to endoscopy in an ASA grade 5 patient: lessons learned.
abstract: We present a 74-year-old woman, who developed massive haematemesis and hypovolaemic shock. Her management was challenging, as the bleeding site could not be identified during oesophagogastroduodenoscopy, she was not fit for a general anaesthesia and not able to lie flat due to heart failure, caused by pericardial effusion. She underwent an emergency laparotomy and gastrotomy under a combined thoracic epidural and lumbar spinal regional anaesthesia in a sitting position, 45° to horizontal plane. The bleeding site was identified as a Dieulafoy lesion on the posterior wall of the stomach and was controlled by under running the lesion. She had an uneventful recovery and is symptom-free post-surgery for a year at present.
authors: Department of Emergency Medicine, Noth Middlesex University Hospital, London, UK. gdemcy@hotmail.com
authors: George A
authors: GA
authors: Demetriou
authors: Manojkumar S
authors: MS
authors: Nair
authors: Eoin
authors: E
authors: Dinneen
authors: Olu
authors: O
authors: Oluwajobi
mesh_terms: D000368:Aged; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007813:Laparotomy / Q000379:methods; D009367:Neoplasm Staging; D012955:Societies, Medical; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D014481:United States