SMALL BOWEL ULCERS – A RARE CAUSE OF MASSIVE DIGESTIVE HAEMORRHAGE: CASE REPORT

Abstract

Ulcerations of the small bowel represent a lack of substance of the intestine wall, which comprises or exceeds the submucous layer. The frequency of their occurrence is low: 40-50 for 100,000 inhabitants/year. Most of the times, they have ranging between 0.4 - 4 cm in diameter and occur more frequently at the level of the terminal ileum, especially on the antimesostenic edge, because vascularization is lower at this level by comparison to the mesostenic edge. Multiple ulcerations of large size may be accompanied by a vital complication, namely massive bleeding, for which the therapeutic attitude implies, in most cases, the association of surgical treatment. A patient of 61 years of age, diabetic, at a phase of multiple cardio-vascular and visceral complications, who, after having followed an intensive treatment with non-steroid anti-inflammatory medication 4 tablets / day for a week, is showing an episode of massive digestive haemorrhage with a decrease in haemoglobin values from 11.3 g/dl down to 5.6 g/dl and for whom the therapeutic solution was represented by surgical intervention with segmental enterectomy for multiple bleeding ulcerative lesions of the ileum. The post-operatory evolution has been a positive one, normal haemoglobin values have been re-established. Although massive digestive haemorrhages having as source ulcerations of the small bowel represent life threatening situations, permanent monitoring of the patient in the intensive care unit, careful hydro-electrolytic rebalancing, blood transfusions as well as surgical treatment applied at the right time may lead to a favourable outcome.