Obscure-Overt Gastrointestinal Bleeding in the Intensive Care Unit

Dr Sanjay Rau DO

7 hours ago

3,019 2 minutes read

Speaker Name: Dr Sanjay Rau DO
Category: (Poster Presentation)
Gastroenterology/Endoscopy

Dr Sanjay Rau DO¹ and Dr Argun Can MD², ¹10800 Knights Road, Philadelphia, PA 19114, Jefferson Health Northeast, ²10800 Knights Road, Philadelphia, PA, 19114, Jefferson Health Northeast

Biography: Dr Sanjay Rau DO is a second year internal medicine resident at Jefferson Health Northeast with an interest in gastroenterology.

Global Journal of Gastroenterology & Hepatology Research [GJGHR]

Gastrointestinal bleeding (GIB) is a common disorder encountered in the intensive care unit (ICU). A GIB with no obvious source identified after investigation is designated as obscure. This designation can be classified as overt or occult. In overt bleeding, there is large blood loss commonly presenting as hematochezia, melena, or hematemesis. Occult bleeding is identified through hemoccult or FOBT testing. We present a complicated patient case with two short-interval episodes of profound obscure-overt GIB that ultimately proved fatal.

A 59-year-old male with a medical history of anemia and prostate cancer status post prostatectomy presented with one day of hematemesis. In the emergency department, patient had large volume hematemesis requiring intubation. Endoscopy was only notable for a small gastric blood clot that was deemed unlikely to cause massive bleeding. He was ultimately transferred to a tertiary care hospital and required massive transfusion protocol (MTP). Additional imaging including mesenteric angiography showed no bleeding. Patient remained hemodynamically stable until day 8, when he experienced hypotension with drop in hemoglobin, again requiring MTP. Work up including endoscopy, angiography, and surgical exploration were performed, with no clear source identified. Patient declined and was ultimately transitioned to comfort measures.

This case demonstrates an example of obscure-overt GIB in the ICU. A standard approach to obscure-overt GIB in the ICU has not been clearly elucidated. Recent literature suggests that there is a role for additional interventions that allow for exploration of the small bowel. For diagnostic purposes, video capsule endoscopy (VCE) may serve as an additional tool for detection of the culprit lesion (1). Additionally, balloon assisted endoscopy can aid in both diagnosis and treatment of obscure-overt GIB in the critical care setting (2). The growing utilization of these more advanced gastrointestinal modalities play a complementary and novel role in the management of GIB in the ICU(3).

Keywords: Obscure-Overt Gastrointestinal bleeding, Intensive Care Unit, Massive Transfusion Protocol, Endoscopy, Video Capsule Endoscopy, Balloon Assisted Endoscopy

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