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Acute gastrointestinal bleeding due to oesophageal varices: an unusual case of a thoracic spleen

Intensive Care Medicine
Publication Date
DOI: 10.1007/s00134-009-1696-9
  • Correspondence
  • Biology
  • Medicine


Gerrit C. Hagenah Jens-Gerd Scharf Alexander Emmert B. Michael Ghadimi Friedrich A. Scho¨ndube Bernhard C. Danner Acute gastrointestinal bleeding due to oesophageal varices: an unusual case of a thoracic spleen Accepted: 17 September 2009 Published online: 21 October 2009 � The Author(s) 2009. This article is published with open access at Case report Upper gastrointestinal bleeding is often seen in patients admitted to intensive care units. Ulcers are the most common cause of these haem- orrhages, but other factors such as oesopageal varices or malignancy may also be sources [1]. We report a 36-year-old male patient (BMI \ 30 kg/m2) admitted to hospital because of a first session of haematemesis and recurrent dysp- noea only days before. Patient’s history revealed only 15 years of nicotine abuse and an undefined infection episode 17 years ago. On admission, clinical examina- tion, vital parameters, chest X-ray and ECG findings were unremarkable. Initial laboratory tests revealed no pathologic coagulation tests, but impaired hemoglobin levels (12.3 g/dl). An oesophagoscopy was per- formed and revealed varices grade 3 [2]. Nine consecutive ligatures were placed. Furthermore, since there was no history or ultrasonic findings of liver disease, a thoracic CT scan was performed, revealing a large retro- cardial mass (12 9 12 9 6 cm, Fig. 1) between the main bronchi displacing the oesophagus. An endosonography excluded an infiltration of the oesophagus, and a pathological specimen taken by video-assisted thoracoscopy showed a vascularised tumor without malig- nancy. Meanwhile, an emergency oesophagoscopy was indicated due to another session of haematemesis with need for mass transfusion. In the following days, an anterolateral right- sided thoracotomy with tumor resection followed. The arterial delivery was provided by a number of bronchial arteries of both main bron- chi. The cause of the paraoesophageal plexus varices was more likely the tumorous venous drainage

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