Coeliac axis ligation in a case of unmanageable upper gastrointestinal haemorrhage

Abstract

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.

• Coeliac axis ligation
• upper gastrointestinal haemorrhage