Saturday, April 11, 2009


The images show a deep stomach ulcer that bled causing sudden and profuse hematemesis. Stomach and bowel were distended by bloody content. The cause of death was hypovolemic shock.


Anonymous said...

Dear Luciano,
I have some doubts: was the pacient a chronic alcoholist? Did you see ascitis or other signs of portal hypertension?

The basic cause of the ulcera was H. pylori infection?!

That is truely an amazing case. Good job!

Adriana Façanha.

Luciano Franco said...

Unfortunately, complications of untreated gastric ulcer are more common than you think: one of our professors has one.
Answering your questions:
1 - I do not remember if he was an alcoholic but probably was.
2 - the relationship between Helicobacter pylori infection and this gastric ulcer is difficult to prove because autolytic phenomena affect the preservation of microorganisms.
But you should remember (or remember to forget):
1 - "Currently, 70% of all gastric ulcers occurring in the United States can be attributed to H pylori infection." (eMedicine).
2 – Forget the footnotes: in this case, there is no Zollinger-Ellison syndrome.
3 – Note that esophageal varices (portal hypertension) are not the "only" cause of hematemesis.
Thanks for your patience.
Luciano Franco.