Really bad GI bleeder…


We’ve all had them…the really, really bad GI bleeder.  Thus man came in peri-code.  He was resuscitated with massive-transfusion to somewhat clinically stable.  After NG tube initially showed over a liter of blood return it stopped, couldn’t be lavaged or suctioned, and his abdomen started distending over the course of the next 1/2 hour.  We decided to get a CT scan to evaluate the distension and this is what was found: Gastric varices 2CT gastric varicies

The abdominal CT with contrast shows very large varicies extending into the stomach!  His stomach has several fluid densities consistent with hematoma, blood, and an area concerning for active exstravasation.  On the coronal image you can also see some dependent ascites around the liver.  The distal portion of the nasogastric tube is thought to have been obstructed by the large hematoma in his stomach.

The patient ended up improving with octreotide and correcting his INR of 3.5.  He had an esophagogastroduodenoscopy (EGD) which confirmed varicies and several were banded.

WARNING:  CT abdomen is not a usual imaging modality for GI bleeders.  We obtained imaging because the patient had increasing distension and abdominal pain.  We wanted to rule out aortic pathology, mesenteric ischemia, hemorrhagic malignancy, gastric perforation, and other pathology that sometimes can be associated with GI bleeding.  I don’t advocate CT imaging in most GI bleeders.

Author:  Russell Jones, MD

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EMREMS: Radiology in Emergency Medicine

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