Surgical treatment of massive upper gastrointestinal bleeding in octogenarian

Abstract

Acute upper gastrointestinal bleeding is a potentially life-threatening abdominal emergency condition. More immediately life-threatening is massive upper gastrointestinal bleeding resulting in cardiovascular compromise causing dizziness, syncope and shock.

The causes of upper gastrointestinal bleeding include bleeding peptic ulcer, Mallory-Weiss tears, acute stress gastritis, Dieulafoy lesion, non-steroidal anti-inflammatory drugs induced bleeding and neoplasms.

The management of massive upper gastrointestinal bleeding entails resuscitation with intravenous fluids and blood transfusion, urgent diagnostic esophagogastroduodenoscopy andpossible intervention.Endotracheal intubationis done to protect the airway in situation of high risk of aspiration from altered sensorium following shock. Intravenous proton pump inhibitor is given. There shouldbe a collaborative teamworkbetweengastroenterologist andthe surgeon.

We report two octogenarians that presented with massive upper gastrointestinal bleeding that were treated by surgery and had good outcome. The aim of this study was to emphasize the need for early surgical intervention in massive upper gastrointestinal bleeding especially in elderly whose functional reserve is markedly depleted with poor tolerance to acute blood loss.