López-Tomassetti Fernández Eudaldo M, Herrero Segura Antonio, González Hermoso Fernando
Department of Surgery, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
Scand J Gastroenterol. 2005 Apr;40(4):486-9. doi: 10.1080/00365520510012091.
Upper gastrointestinal haemorrhage (UGH) is a frequent reason for referral in gastroenterologic practice. It consists of bleeding that originates in the upper gastrointestinal tract, between the oesophagus and Treitz's angle. Gastroduodenal peptic ulceration, severe lesions of gastric or duodenal mucosa, and esophageal varicose rupture are the most frequently reported causes of UGH. Clinically, it manifests as rectal bleeding or haematemesis. Regardless of the causal lesion, UGH is differentiated by the degree of haemodynamic instability. Thus, initial management of UGH with haemodynamic instability does not depend on the lesion that produces it but rather on controlling the hypovolaemia in all cases. Subsequent therapeutic measures, which in certain cases are defined in early stages of this picture, depend on the aetiology of the lesion causing the UGH and its treatment. We present a case of unmanageable UGH of unknown aetiology despite multiple diagnostic and therapeutic measures, where final successful treatment required an exceptional surgical intervention--celiac axis ligation.
上消化道出血（UGH）是胃肠病学实践中常见的转诊原因。它是指起源于上消化道（食管与Treitz韧带之间）的出血。胃十二指肠消化性溃疡、胃或十二指肠黏膜的严重病变以及食管静脉曲张破裂是UGH最常见的病因。临床上，UGH表现为便血或呕血。无论病因如何，UGH都根据血流动力学不稳定的程度进行区分。因此，对血流动力学不稳定的UGH进行初始处理并不取决于引发它的病变，而是在所有情况下都要控制血容量不足。后续的治疗措施，在某些情况下在疾病早期就已确定，取决于导致UGH的病变病因及其治疗方法。我们报告了一例病因不明且难以处理的UGH病例，尽管采取了多种诊断和治疗措施，但最终成功治疗需要进行特殊的手术干预——腹腔干结扎术。
