Postmortem diagnosis of massive gastrointestinal bleeding

Abstract

Giant peptic ulcers have a poor prognosis and are associated with more frequent bleeding, together with very high morbidity. The prognosis worsens if it also spreads to the duodenum, with probable involvement of adjacent organs such as the pancreas. The most serious complication of these is perforation, this being the first manifestation is up to a third cases. A 62-year-old male patient with a history of high blood pressure, progressive cognitive disorder, and complications related to alcohol abuse and smoking. The patient came to the emergency room complaining of frequent stools mixed with blood. Ten hours after admission, he experienced massive hematemesis, followed by cardiorespiratory arrest and death. An autopsy was requested. In the pylorus and the first portion of the duodenum, an ulcerated lesion measuring 6.5 × 5 cm was identified, with smooth and raised edges, a fibrinoid bottom and a blackish appearance. During the histological study, an abrupt transition between the mucosa and the ulcerated area was observed, with involvement of the pancreas, the ampulla of Vater and adjacent tissues. Signs of hypersecretory hypertrophic gastropathy were found, with no signs of malignancy or associated Helicobacter pylori . Complicated giant peptic ulcers represent a medical emergency associated with increased morbidity, mortality, and costs. The variability of the associated symptoms makes it difficult in certain cases to identify the risk of massive bleeding, which eventually manifests as significant hematemesis due to vascular involvement. Complications, such as perforation and penetration, are important mortality risks, which make up a wide spectrum of signs and symptoms that precede a fatal outcome, which correspond to the autopsy findings of the case presented here.