Acute Gastric Ulcer with Massive Upper Gastrointestinal Hemorrhage: An Autopsy Case Report
Abstract
The case fatality rate of acute gastric ulcer with massive upper gastrointestinal hemorrhage is high. We report a case of a 50-year-old male who admitted due to bleeding per urethra after he pulled out his catheter. He was managed for acute retention of urine secondary to benign prostatic enlargement but unfortunately, he was self-administering ibuprofen without the knowledge of his physicians. He started passing massive dark blood per rectum few minutes before he was certified dead. The autopsy examination showed massive gastrointestinal hemorrhage, acute gastric ulcer, shocked kidneys and benign prostatic enlargement.
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Introduction
A 50-year-old male presented at the Emergency unit with complaint of bleeding per urethra of a day duration after he pulled out his catheter. He was catheterized two weeks prior to presentation due to acute retention of urine secondary to benign prostatic enlargement in the same Hospital.
On clinical examination, he was a middle-aged man, conscious in time, person and place. He was not in any obvious distress. He was mildly pale, anictericand had no pedal oedema. He was afebrile and with a pulse rate of 85bpm (Reference Value {RV} 85-145bpm). His blood pressure was 110/70mmHg and with a respiratory rate of 18 cycles per minute (RV: 12-20 per minute). The abdomen moved with respiration and was not tender. The liver and spleen were notpalpable and the kidneys were not ballotable. Other systems were essentially normal.
His laboratory work-up disclosed hemoglobin of 8g/dl (RV:11.5-16.5g/dl), leukocytes of 16.12 x 10 9 /L (RV:3.5 – 10.0 x 10 9 /L), platelet count of 157 x 10 9 /L (RV:100 – 400 x 10 9 /L), serum sodium of 142.6mmol/L (RV:135 – 155mmol/L), serum chloride of 101.8mmol/L (RV: 96 – 110 mmol/L), serum potassium of 3.8mmol/L (RV: 3.5 – 5.4mmol/L), serum creatinine of 78.2mmol/L (RV: 60 – 120mmol/L), serum urea of 3.7mmol/L (RV: 2.5 – 6.5 mmol/L). His urine culture and sensitivity revealed Escherichia coli organisms.
He received antibiotics, intravenous fluids and a pint of blood while he was hospitalized. His caregiver revealed he was on self-administered tablets of ibuprofen and at about thirty hours after admission, he passed massive dark blood per rectum and he was found to be severely pale. His hemoglobin was 6g/dl (RV:11.5-16.5g/dl). He was noticed to be gasping for breath and efforts at resuscitation was unsuccessful. He was certified dead 10 minutes after passing massive dark blood per rectum and the body was sent to the morgue for autopsy.He was managed as a case of urosepsis on a background benign prostatic enlargement and upper gastrointestinal hemorrhage.
Conclusion
Acute gastric ulcer may become complicated due to massive gastrointestinal hemorrhage. In such scenarios the fatality rate is high and it carries ominous prognostic implication. The patient was admitted into the hospital, but he was self-administering non-steroidal anti-inflammatory drugs. This case highlights the importance of continuous and vigilant drug history review among patients on admission in a health facility. The postmortem examination was essential to clarify the cause of death.