A 77-year-old man was referred to the hospital emergency department from his primary care centre for assessment of seizures.
As a personal history, the patient reported upper gastrointestinal bleeding two years earlier, in the context of taking aspirin by catarrhal process, as well as recurrent renoureteral crisis (URC) and asthma.
At that time, no more information was available on her personal history.
The patient was taking inhaled corticosteroid treatment.
He was diagnosed three days before the CRU in his health center due to low back pain with a colic profile radiating to the lower left quadrant. He had received intramuscular diclofenac and aspirin on demand, with partial relief.
Emphasis is placed on the diagnosis.
In the emergency department, the patient reports, in addition to irradiated low back pain, which she recognizes as having characteristics similar to previous URC, the presentation in the last eight hours of heartburn, as well as tremor, when rising.
He had also experienced three vomiting bloody mild.
Physical examination revealed good general condition, TA of 70/50 mm with normal capillary refill, HR of 90°, ta of 36°, nausea-coloured rectal mucosa, nasal dryness with normal abdomen and tender abdomen.
Samples were extracted for analytical and cross-testing, and serum therapy was initiated with two peripheral venous lines, which returned the tensional figures without normalizing them.
In the analytical, Hb, 12.9 g/dL, Hto.
3 leukocytes 27.500/μL with 87% neutrophils, platelets and coagulation normal; urea 52 mg/dL, creatinine 2.86 g/dL; rest normal.
This situation of hemodynamic instability and digestive endoscopy in a patient with a history of upper bleeding and current treatment with potentially gastro-intestinal drugs was requested.
Immediate endoscopy showed an oesophagus with mucosa clearly ischemic from 30 cm and 38 cm, as well as fundus, notch, notch and necrotic gastric body normal, with minimal gastric remnants.
During endoscopy, the patient developed cardiorespiratory arrest due to pulseless electrical activity.
The resuscitation maneuvers were unsuccessful and the patient died.
The retroperitoneal hemorrhage revealed acute necrotizing erosive extension at 14 cm distal and ro aortic cavity, predominantly abdominal and bifurcated iliac, with saccular aneurysm in the abdominal aorta of approximately 13 cm long and 8 cm long.
