Duodenal Ulcer Complicated with Massive Upper Gastrointestinal Bleeding: Case Report

This case report aims to present a severe manifestation of duodenal ulcer complicated by massive upper gastrointestinal bleeding and critically low hemoglobin levels, highlighting the importance of early recognition, immediate intervention, and a multidisciplinary approach in managing patients at imminent risk of hemodynamic instability. A 64-year-old male patient with a recent history of orthopedic surgery and exploratory laparotomy was admitted to the emergency department in a coma, presenting signs of hemodynamic instability, severe anemia (hemoglobin 2.8 g/dL), metabolic acidosis, elevated lactate levels, and clinical features of septic shock originating from a surgical wound infection. The patient was intubated, received fluid resuscitation and blood component transfusion, and was admitted to the intensive care unit (ICU). Emergency upper gastrointestinal endoscopy revealed an actively bleeding duodenal ulcer classified as Forrest IB, with abundant clots. Despite endoscopic treatment with adrenaline injection, hemodynamic instability persisted, necessitating surgical intervention. Exploratory laparotomy confirmed a 30 mm bleeding ulcer, which was treated with duodenorrhaphy and omentoplasty. The patient showed clinical improvement postoperatively and was transferred from the ICU to the surgical ward. This case underscores the importance of prompt diagnosis and timely intervention in patients with severe upper gastrointestinal bleeding due to duodenal ulcer.