[Lethal cases of bleeding to the upper gastrointestinal tract]

We report three lethal cases of bleeding to the upper gastrointestinal tract as immediate cause of death. The first two cases are in connection with homelessness. First is a male who was found dead in a railway station, seated on a bench with dried blood beneath him. The second is a male who was found lifeless in a wooden shelter, where upon the good will of the landowners, he lived. At autopsy, gastroduodenal ulcer disease with a damaged blood vessel at the ulcer base was found in both. The cause of death was stated as hypovolemic shock, arising from loss of blood from bleeding gastroduodenal ulcer disease. The third case shows a man with liver cirrhosis, who was transported to hospital when his health deteriorated, where he died with blood vomiting. The case was closed as hypovolemic shock from loss of blood and was ascribed to haemorrhagic diathesis and chronic liver insufficiency, and excluded haemoptysis as the cause of the bleeding. The paper draws attention to the risk of mortality in patients with gastroduodenal ulcer disease, with irregular food intake, including alcohol abuse. The cases demonstrate the importance of medical care for patients who are prone to gastric ulcers, or to patients who have been diagnosed and/or treated for gastroduodenal ulcer disease, as the severe risk of ulcer bleeding, leading eventually to ulcer perforation. Our case reports may inform ambulance crews responding to at-risk individuals, such as homeless people, to the immediate threat of possible gastroduodenal ulcer disease with ulcer bleeding, or ulcer perforation.Key words: bleeding - death - gastric ulcer - gastroduodenal ulcer disease - nutrition - preventive medicine.