Gastric Tube Ulcer that Could Be Saved by Early Conservative Treatment

The patient was an 81-year-old man who had received subtotal esophagectomy for esophageal cancer reconstructed by a gastric tube via a posterior mediastinal route. He presented to our emergency room with a complaint of epigastric pain and a small amount of hematemesis. Thoracoabdominal computed tomography showed that the reconstructed gastric tube was filled fluid and had irregular wall thickening. We suspected upper gastrointestinal bleeding, and we started to treat with administration of proton pump inhibitors (PPIs) since the anemia was mild and his vitals were stable. However, his anemia was rapidly progressed to Hb 6.0 with a large amount of old blood melena. The emergency gastroscopy showed an A2 stage ulcer with active oozing at middle esophagus reconstructed by a gastric tube. Therefore, we applied thrombin spray to treat the bleeding. Fortunately, his recovery was progressing nicely with medical treatments for a week. In this study, we experienced a case in which early administration of PPIs might be a key player to prevent his medical condition worsened further.

Automated summary

This is a case of an 81-year-old male patient who underwent esophageal cancer surgery with gastric tube reconstruction. He presented with epigastric pain and hematemesis. CT scan showed fluid-filled gastric tube with wall thickening. Upper gastrointestinal bleeding was suspected and treated with PPIs. However, the patient's anemia worsened rapidly with melena. Emergency gastroscopy revealed an active bleeding ulcer, which was treated with thrombin spray. The patient had a good recovery after a week of medical treatment.