TITLE:
Acute Massive Upper Gastrointestinal Bleeding Secondary to Post-Burn Stress: A Case Report
AUTHORS:
Hynd Hedda, Hanae Idrissi, Dafr-allah Benajah, Sidi Adil Ibrahimi, Nada Lahmidani
KEYWORDS:
Gastrointestinal Bleeding, Post-Burn Stress, Long-Term Strategies
JOURNAL NAME:
Open Access Library Journal,
Vol.12 No.10,
October
29,
2025
ABSTRACT: Severe burns can readily induce gastric and duodenal mucosal erosions and superficial ulcers. In severe cases, hemorrhage or perforation of peptic ulcers might occur, threatening the lives of patients. Currently, gastrointestinal bleeding following burns is primarily managed with medication and gastrointestinal endoscopy. However, the combined multidisciplinary approach of gastroscopy and vascular embolization remains uncommon. A teenager, aged 18 years old, was admitted to the intensive care unit after Self-inflicted burns. Upon admission, he presented with third-degree burns covering approximately 60% of his total body surface area (TBSA). On the 4th day after the injury, the patient developed significant upper gastrointestinal bleeding (massive melena), with a drop in hemoglobin from 16 g/dl to 8 g/dl, indicating a critical drop in his blood levels. Immediate intervention was necessary to stabilize the patient and address the source of the bleeding effectively. Under the guidance of a multidisciplinary team, a gastroscopy examination was performed and showed bleeding from the oeso-gastro-duodenal tract. The gastroscopy showed that there were multiple areas of ulceration and erosion, from the esophagus to the bulb with a Curling ulcer of the bulb, likely a result of stress-induced mucosal disease exacerbated by the patient’s critical condition. Prompt treatment was initiated, which included intravenous fluids and blood transfusions to restore hemoglobin levels, alongside the administration of proton pump inhibitors to manage gastric acidity and promote healing of the mucosal lining. Following the initiation of continuous intravenous proton pump inhibitor (PPI) therapy, the patient did not experience any recurrence of hemorrhage. However, the patient developed severe sepsis, which progressed to septic shock accompanied by disseminated intravascular coagulation (DIC). Effective management of gastrointestinal bleeding requires a comprehensive approach that not only addresses the immediate crisis but also involves long-term strategies to prevent recurrence and promote overall digestive health.