Massive Oesophageal Variceal Bleeding
- 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.
- A nasogastric feeding tube was also inserted.