This 43 year old male had spontaneous vomiting of blood due to oesophageal varices from alcoholic liver failure.
The initial management of patients with acute variceal haemorrhage includes haemodynamic resuscitation, ensuring the patient’s airway is protected, and addressing any coagulopathies that are present. Patients also receive prophylactic antibiotics.
Vasoactive medications are also commenced at the time of acute presentation, as they decrease portal blood flow, and, as a group, have been shown to decrease mortality and improve haemostasis.
Upper endoscopy should be performed for diagnosis and treatment in patients with suspected variceal bleeding within 12 hours of presentation.
In this case, on emergency endoscopy, extensive blood and clot was encountered.
A temporary tamponading balloon was inserted followed by banding of the varices the following day.
Endoscopic sclerotherapy is another treatment option for bleeding oesophageal varices.
Both methods are successful in 80-90% of patients.
