Refractory Nonvariceal Upper Gastrointestinal Bleeding Requiring Surgical Intervention.

Area of Science:

• Gastroenterology
• Interventional Radiology
• Surgical Management

Background:

• Nonvariceal upper gastrointestinal (GI) bleeds represent a significant medical emergency with high mortality rates, particularly in inpatient settings.
• Standard management involves resuscitation followed by endoscopic, transcatheter arterial embolization (TAE), or surgical interventions.

Observation:

• A 55-year-old female with multiple comorbidities experienced a refractory second episode of acute nonvariceal upper GI bleeding.
• The patient underwent a multidisciplinary approach including endoscopy, embolization, and ultimately surgery due to persistent bleeding post-embolization.

Findings:

• Rebleeding after initial hemostasis for upper GI bleeds is a recognized complication.
• Second endoscopic attempts may be challenging in cases of brisk rebleeding.
• The role of prophylactic embolization in nonvariceal upper GI bleeds remains controversial.

Implications:

• Early collaboration between interventional radiology and surgery is crucial for managing complex nonvariceal upper GI bleeds.
• Prompt surgical assessment is vital for patients with refractory bleeding unresponsive to endoscopic or embolic therapies.
• This case underscores the importance of a comprehensive, interdisciplinary strategy for optimizing outcomes in severe upper GI bleeds.