title: Severe necrotic oesophageal and gastric ulceration associated with dabigatran.
abstract: A 69-year-old Caucasian man, who had been discharged 2 days previously, 5 days post-elective right total hip replacement, was re-admitted with a 16 h history of coffee-ground vomiting and epigastric pain. He had been discharged with 220 mg dabigatran, a novel oral anticoagulant. The coffee-ground vomiting started within minutes of taking the first dose. Haemodynamic compromise, agitation, decreasing conscious level and aspiration pneumonia necessitated intubation, ventilation and inotropic support in the intensive care unit. A CT on admission showed extensive intramural air seen within the lower oesophagus and a dilated stomach, duodenum and jejunum. Endoscopy of the upper gastrointestinal tract showed extensive ulceration, sloughing and multiple areas of necrosis in the distal oesophagus and stomach. The patient made a fully recovery with supportive management.
authors.affiliation: Department of Surgery, Barnet and Chase Farm Hospitals Trust, London, UK. saurabh.singh@nhs.net
authors.forename: Saurabh
authors.initials: S
authors.lastname: Singh
authors.forename: Louis
authors.initials: L
authors.lastname: Savage
authors.forename: Martin
authors.initials: M
authors.lastname: Klein
authors.forename: Cherian
authors.initials: C
authors.lastname: Thomas
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000009:adverse effects*; D001562:Benzimidazoles / Q000009:adverse effects*; D000069604:Dabigatran; D004935:Esophageal Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D004945:Esophagoscopy; D005773:Gastroscopy; D006801:Humans; D008297:Male; D009336:Necrosis / Q000139:chemically induced; D011015:Pneumonia, Aspiration / Q000139:chemically induced; D013276:Stomach Ulcer / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014839:Vomiting / Q000139:chemically induced; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran