Authors: Aaron Woofter, MD; Richard Goodgame, MD Series Editor: Richard Goodgame, MD

Disclosures

August 22, 2006

Clinical Course

The patient underwent upper gastrointestinal endoscopy. The esophagus was normal. A 2-cm ulcer oozing blood (Figures 1 and 2) was seen 2 cm beyond the gastroesophageal junction along the lesser curve of the stomach. There were 6 other ulcers scattered throughout the corpus of the stomach (Figures 3 and 4). The antrum and duodenum were normal.

Figure 1.

The ulcer was seen just beyond the gastroesophageal junction in the proximal stomach.

Figure 2.

The gastroscope is looking back upon itself to show the proximal stomach from where the bleeding is coming.

Figure 3.

Multiple other ulcers were seen in other parts of the body of the stomach.

Figure 4.

The ulcers that are not actively bleeding are smaller and more superficial.

The bleeding ulcer was treated with epinephrine injection and BICAP (bipolar circumactive probe) cautery (Figure 5).

Figure 5.

An injection catheter was used to inject epinephrine into the ulcer base to achieve hemostasis.

Hemostasis was achieved. The lesions were thought to be classic for stress-related gastric ulcerations (described previously). A continuous proton-pump inhibitor (PPI) infusion was maintained for 4 days and then an oral PPI was given twice daily. He had no further episodes of overt gastrointestinal blood loss, but did require 2 additional units of blood. The patient was discharged from the surgical ICU after 10 more days and was then discharged back to prison after 1 month. Renal function returned to normal and wound healing was achieved.

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