case_images: PMC11812061_01
case_images: CT examination results of the patient's abdomen. Note: (A) CT examination performed in the outpatient clinic; (B) whole-abdominal enhanced CT during ICU stay; (C) Abdominal CT examination of the second review during ICU stay. The red arrow indicates the gradually expanding necrotic exudation area of the pancreas, and the yellow arrow indicates portal venous occlusion.
case_images: fsurg-11-1471966-g001.jpg
case_images: PMC11812061_01_fsurg-11-1471966-g001.jpg
case_images: F1
case_images: The CT scan of the entire abdomen in outpatient department (Figure 1A) indicated: (1) Signs of AP, peritoneal inflammatory changes; (2) Abdominal pelvic effusion, bilateral pleural effusion; (3) Gallbladder duct stones, fatty liver. During ICU treatment, a whole-abdominal enhanced CT examination (Figure 1B) disclosed signs of acute necrotizing pancreatitis along with accumulation of peripheral necrosis, embolism in the portal vein and superior mesenteric vein, and peritoneal inflammatory alterations. Abdominal CT examination of the patient a few days later (Figure 1C) showed signs of acute necrotizing pancreatitis with accumulation of surrounding necrosis and increased necrosis.
case_images: The first gastroscopy results of the patient after admission to ICU. Note: (A) Is esophagus, (B-D) are cardia of stomach, (E,F) are corpus of stomach, (G) is antrum of stomach, (H) is duodenal bulb segment. Upon entering the esophagus, remnants of blood were distinctly visible. Subsequent suctioning of the area revealed no discernible bleeding points within the esophagus. However, within the stomach cavity, a significant accumulation of blood clots and scabs was encountered. Following a thorough rinse with water, a substantial area of the stomach's cardia and corpus exhibited a pronounced mucosal denudation. To address this, a solution of diluted Adrenaline, mixed with saline, was meticulously sprayed onto the affected regions of the corpus and cardia. Further examination unveiled a minute ulceration in the antrum, characterized by a white coating at its base. Notably, there was no evidence of active bleeding, nor were any bleeding lesions detected in the duodenal bulb or its descending segment.
case_images: fsurg-11-1471966-g002.jpg
case_images: PMC11812061_01_fsurg-11-1471966-g002.jpg
case_images: F2
case_images: On the 13th day after the patient was admitted to the ICU, he endured a severe episode of hematemesis accompanied by substantial blood clots, following the electronic gastroscopy examination (Figure 2), a notable detachment of a substantial mucosal layer was discerned in the fundus and body regions of the stomach.
case_images: Results of the second gastroscopy after admission to ICU. Note: In this illustration, (A) represents the esophagus, (B) signifies the gastric fundus, (C,D) denotes the gastric body, and (E) is the gastric antrum. The esophagus exhibits a smooth and supple mucosa, characterized by a distinct and well-defined blood vessel pattern that indicates excellent distensibility and elasticity. In the gastric fundus, abundant fresh blood and clots suggest hemorrhage. The stomach body, gastric angle and antrum show large mucosal avulsion, mucosal roughness, diffuse bleeding, indicative of significant damage.
case_images: fsurg-11-1471966-g003.jpg
case_images: PMC11812061_01_fsurg-11-1471966-g003.jpg
case_images: F3
case_images: Subsequently, we conducted a second follow-up gastroscopy on the patient (Figure 3), and discovered large mucosal detachment, diffuse bleeding in the main body of the stomach, the angle of the stomach and the antrum, and mucosal irregularization.