A Case of Esophageal Ulcers with Hemorrhagic Shock Undergoing Emergent Esophagectomy

Haruhumi Makino, Koji Soeda, Kazuaki Okuyama, Teruo Kouzu, Shouichi Onoda, Kaichi Isono

Second Department of Surgery, Chiba University School of Medicine

We report a case of hemorrhagic esophageal ulcers. The patient, a 41-year-old man who had been salesman of household drugs, had four sequential episodes of hematemesis. An incision was made in the stomach at the first, but the location of the bleeding could not be detected. At the second episode, emergency endoscopy showed esophageal ulcers in the middle part of the esophagus (Lm), and in the inferior part of the esophagus (Li) with bleeding. Ethanol was injected into the ulcer in Li. At the third episode, he was admitted to our clinic. Endoscopy on admission revealed exposed vessels in the ulcer in Lm and a healing tendency in the ulcer in Li. He had hematemesis a fourth time with hemorrhagic shock, and arterial bleeding in the ulcer in Lm was noted, but hemostasis by endoscopy could not be performed. An emergency operation was started soon after a blood trnasfusion. After the esophagus ligated at the both side of the ulcer in Lm through a right thoracotomy, his shock improved dramatically and an esophagectomy was performed successfully. The resected specimen contained two irregular and deep ulcers. He was discharged with no complications on the 64th postoperative day. We assume that these ulcers were drug-induced considering his occupation and habits. We recommend operative ligations of the esophagus at the upper and lower sides of the ulcer, if massive and uncontrolled bleeding with shock develops.

Key words
esophageal ulcer, hemorrhagic shock, esophagectomy

Reprint requests
Haruhumi Makino Second Department of Surgery, Chiba University School of Medicine
1-8-1 Inohana, Chiba, 280 JAPAN

Accepted
April 17, 1991

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