Protocol-based guidelines and acute upper gastrointestinal hemorrhage: RESULTS (Part 3)

Surgery

First phase: Two patients, both males over the age of 75 years with a risk score of more than four, required surgery. They had diagnostic and therapeutic endoscopies within 24 h of admission and were each found to have a duodenal ulcer. Both required a second therapeutic EGD for rebleed and had oversewing of the bleeding ulcer at surgery. They were admitted to the HDU. One of them had severe respiratory comorbidity and died from respiratory failure postoperatively. The second patient was successfully discharged home three weeks after surgery.

Second phase: Two patients had surgery. A 15-year-old girl had collapsed secondary to a bleeding vascular malformation in the duodenum. Therapeutic intervention at endoscopy failed to stop the bleeding. Under-running of the vascular malformation was done at surgery. The other patient, a medical inpatient, had hematemesis from a gastric carcinoma diagnosed at endoscopy. At surgery he was found to have an inoperable gastric cancer. The patient was kept comfortable and died postoperatively.

Mortality

First phase: Eight (14%) patients in the study died in hospital and/or within 30 days. They were all over the age of 79 years. Their average age was 87.5 years, median age 88 years with a range of 79 to 95 years. One refused any active intervention. Three suffered cerebrovascular accident before any therapeutic measures were instituted. One died postoperatively from respiratory failure. One had a myocardial infarction, one died of pneumonia and the other of multiorgan failure. The case notes of all the patients were carefully reviewed and it was concluded that their deaths were not preventable. Your drugs could be a lot cheaper and your treatment could be still as safe and efficient as always: all you need to do to get your Symbicort Price is shop at the best pharmacy offering its services to you right here right now.

Second phase: Only four patients (7.5%) died during the second phase. One has been mentioned above. The second patient was a 33-year-old female patient admitted with coffee ground vomiting. Endoscopy was normal. Computed tomography revealed a brain tumour from which she succumbed. A 92-year-old gentleman, known to suffer from carcinoma of the esophagus, had a hematemesis. He was unfit for an EGD and subsequently died. Another, an 89-year-old man had a bleeding gastric ulcer seen on EGD that was injected. He continued to bleed. He was unfit for surgery and was kept comfortable.

 

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