Acute gastrointestinal bleeding – a GIST related emergency
Case report of one of my patients who presented with acute gastrointestinal bleeding under anticoagulation.
A 84 years old woman presented at the emergency department with massive, hemoglobin relevant bleeding (hematemesis, hematochezia, HCT 20% HGB 6,5 g/dl ). The lady had a long term anticoagulant treatment for atrial fibrillation with Acenocoumarol (SINTROM), and several severe comorbidities like COPD, cardiac insufficiency with an ejection fraction <45 %.
The patient suffered of a known tumor of the stomach located at the greater curvature. Computer Tomography, gastroscopy and endoscopic biopsy taken 12 months earlier led to the diagnosis of an GIST of the stomach. A surgical treatment for this tumor has been denied at this time by the patient herself.
Endoscopy showed a tumor with a great size, which is nearly obstructive
After stabilizing the hemodynamic condition with transfusion of 2 units of RBC and 2 FFP the patient underwent subtotal gastrectomy with gastro-jejunostomy and an Omega Braun loop.
Complete macroscopic resection was achieved
The specimen reveals the nearly occlusive tumor which is surrounded by the intact mucosa. Extensive areas of necrosis and hemorrhage can be seen
After successful surgery the patient needed protracted hospitalization to recover. Several postoperative complications like infection of the lower respiratory tract and postoperative paralytic ileus have been manifested.