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Active bleeding from downhill varices: case report and management.

ABSTRACT: Video 1EGD revealing 1 column of nonbleeding grade 2 varices in the middle third of the esophagus at the anterior wall; absent red wale sign and 3 columns of nonbleeding grade 3 varices in the upper third of the esophagus in the anterior and posterior wall. Stigmata of recent bleeding evident, red wale signs present, and 1 white nipple sign identified in the anterior wall, in the same column coming from the middle esophagus. Successful variceal banding ligation was performed, and there was no recurrence of bleeding.

SUBMITTER: Ali AA

PROVIDER: S-EPMC8267966 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Introduction and importance: Ruptured esophageal varices are fatal and cause haemorrhagic shock and consequently death if no immediate intervention is instituted to arrest bleeding. The role of forensic pathologists in investigating cases of sudden unexpected deaths is of paramount importance. Upon medico-legal work ups by forensic pathologists, autopsy would shed light to the exact cause of death as to whether it is natural or unnatural. Case presentation We are reporting an unusual case of an elderly man with alcoholic liver cirrhosis who succumbed to sudden death following ruptured esophageal varices which led to haemorrhagic shock. Clinical discussion Clinical autopsy was carried out to establish the cause of death. Tissue sections from the healed pathologically fractured bone, liver, prostate and esophagus were taken for histological evaluation. The bone tissue showed relative reparative changes and the prostate tissue showed hyperplasia of both stroma and epithelial components. The tissue from the esophagus showed proliferating distended, engorged vascular structures and some were thrombosed (photograph 3). Liver biopsy showed destruction of the normal liver parenchyma by both micro and macro nodular formation which was marked by the thick broad fibrous bands. A conclusive diagnosis of hemorrhagic shock secondary to ruptured esophageal varices caused by alcoholic liver cirrhosis was established as the cause of death. Conclusion Esophageal varices can be the likely cause of sudden death upon rupturing. Rupturing of esophageal varices in individuals with a known long-standing history of alcoholism must always be considered in order to prevent haemorrhagic shock from ensuing. Highlights • Ruptured esophageal varices are fatal and cause haemorrhagic shock.• Decompensated liver cirrhosis is a common cause of upper gastrointestinal bleeding.• Esophageal varices represent the most important complications of portal hypertension.• Alcoholic liver cirrhosis is associated with a significantly higher risk of variceal bleeding than from other causes.• Poor liver function contributes to abnormalities in coagulation.

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Active bleeding from downhill varices: case report and management.

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