Endoscopy 2 case

Case 1.
Liver cirrhoisis terminal stage male patient.
He had melena for 2days.
P/E: chronic ill appearance, icteric sclera.

EGD:

 There were serial of varices from mid esophagus without evidence of bleeding.

 There was exposed vessel with spontaneous bleeding at the just below of EG junction.  Diagnosis was made.. "Dieulapoy ulcer bleeding"

Bleeding control with hemoclips was done. Hemostasis was achieved easily.

I couldn't see the patient today morning rounding. He died of complication of liver cirrhosis.

Since he was in condition of terminal state of liver cirrhosis, his family was already prepared to accept his death.

Case 2.

male, 54 years old

He has been admitted over 1month from complications of liver cirrhosis.

He had encephalopathy, hepatorenal syndrome, varices bleeding, ascites..

He had as many complications as possible. He is also in terminal state of LC.

My junior doctor called me that he had melena this morning. Actually he sometimes had bleeding unknown origin. A few days age, he had done endoscopy but couldn't prove the focus of bleeding.

This time, I myself did the endoscopy.

 EGDS:

  I found the stigmata of bleeding at the mid esophagus. (20cm from incisor)

 I tried to ligate the varices. Because the esophageal mucosa was too fibrosed, the trial failed.

 Bood was spurring from varices of esophagus.

 Histoacryl and lipiodol were mixed and injected into varices directly. (Sclerotherapy)

 Followup endoscopy.. Good result. There was seen well-sclerosed varices bleeding site.

Fantastic!!. This patient has been living through many risky complications. When I see this patient, I think that man can not judge the people's fate.