68-Year-Old Man Survives Life-Threatening Upper Gastrointestinal Bleeding with Combined Medical and Surgical Intervention
Upper gastrointestinal bleeding is a critical medical emergency that requires prompt diagnosis and treatment. In this case study, we explore how a 68-year-old male with a long history of chronic hepatitis B and liver cirrhosis successfully recovered from a severe hemorrhage through timely medical intervention and endoscopic therapy.
Case Overview
Patient: Male, 68 years oldMedical Condition: Acute upper gastrointestinal bleeding secondary to liver cirrhosisHospital: The 988th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation ArmyTreatment Period: December 2021Treatment Approach: Combination therapy including intravenous medications such as octreotide acetate, pantoprazole sodium, magnesium isoglycyrrhizinate, and reduced glutathione, along with diuretics and antibiotics. Endoscopic variceal ligation was also performed.Recovery Timeline: Four weeks of inpatient care followed by outpatient follow-up every three months and long-term home management.
Initial Presentation and Diagnosis
The patient was brought to the emergency department in a critical condition. He was hypotensive, showing signs of shock, with a hemoglobin level of just 56 g/L. His medical history included cirrhosis for 8 years, hypertension for 3 years, and multiple prior episodes of ascites, hepatic encephalopathy, and gastrointestinal bleeding. After consuming a meal containing fibrous food, he suddenly collapsed. Upon arrival, he remained unconscious with no bowel movement and excessive sweating. Following neurological and internal assessments, and after ruling out stroke, the medical team suspected gastrointestinal bleeding. A sudden episode of hematemesis confirmed the diagnosis of upper gastrointestinal bleeding due to esophageal varices caused by cirrhosis.
Comprehensive Treatment Plan
Phase One: Emergency Stabilization
Immediate interventions included intravenous octreotide and pantoprazole, along with blood transfusions to stabilize the patient. Within 72 hours, his hemoglobin levels improved and active bleeding ceased.
Phase Two: Liver Support and Complication Management
As the patient stabilized, complications such as worsening ascites and elevated bilirubin levels were addressed with magnesium isoglycyrrhizinate and glutathione for liver protection. Diuretics were administered to manage fluid retention. Due to elevated white cell count in ascitic fluid, bacterial peritonitis was suspected and treated with cefoperazone-sulbactam.
Phase Three: Endoscopic Intervention and Recovery
After 10 days of supportive care, a gastroscopy revealed severe esophageal varices. The patient underwent endoscopic variceal ligation to prevent future bleeding. He remained under observation for two weeks post-procedure and was eventually discharged with a stable condition.
Outcomes and Prognosis
Following the multi-phase treatment, the patient's liver function largely normalized. His bilirubin and transaminase levels returned to normal, ascites resolved, and peritonitis was controlled. Although albumin levels remained slightly low, the endoscopic procedure significantly reduced the risk of rebleeding. It is important to note that while the variceal ligation is effective, ongoing liver care and dietary management remain essential to prevent recurrence.
Post-Discharge Recommendations
To ensure long-term health and prevent future complications, patients with cirrhosis should follow these guidelines:
- Rest and Lifestyle: Avoid overexertion, stress, alcohol, and stimulants like coffee and tea.
- Dietary Precautions: Avoid raw, cold, spicy, or hard foods. Eat small, frequent meals at moderate temperatures.
- Medication Caution: Avoid NSAIDs like ibuprofen or aspirin unless prescribed, as they can irritate the stomach lining.
- Symptom Monitoring: Watch for black stools or symptoms like acid reflux, bloating, or heartburn, and seek medical help immediately.
- Regular Screening: Undergo gastroscopy every 6–12 months to monitor varices and overall gastrointestinal health.
Clinical Insights
Upper gastrointestinal bleeding can stem from various causes, including peptic ulcers, esophageal varices, erosive gastritis, and malignancies. Identifying the root cause is essential for effective treatment. This case underscores the importance of early diagnosis, timely intervention, and long-term disease management. Patients and families should be educated on risk factors and preventive strategies. Regular health check-ups and prompt medical attention during emergencies can significantly improve outcomes and save lives.