Digestive haemorrhage due to rupture of oesophageal varices in the emergency department

Aims Digestive haemorrhage due to rupture of oesophageal varices is a formidable complication of portal hypertension (PH). It is associated with a high mortality rate, especially in cirrhotic patients.to improve the outcome of these patients.The aim of our study was to evaluate the management of these haemorrhages in an emergency setting.

Methods This was a retrospective study conducted in the emergency department of the HMIMV Rabat from January 2020 to April 2024.The study included 74 patients admitted to the emergency department with upper gastrointestinal haemorrhage due to oesophageal variceal rupture as assessed by oesogastroduodenal endoscopy. Clinical, biologicalendoscopic and therapeutic data were collected from the patients' files.Statistical analysis was performed using SPSS 20 software. Quantitative variables were described in terms of mean and standard deviation, and qualitative variables were described in terms of numbers and percentages.

Results The mean age was 54.3±2.6 years, and the sex ratio was 3.6 (16 females-58 males). 68 patients (92%) had cirrhosis and 6 patients (8%) had portal hypertension in non-cirrhotic livers. 41 patients (55.4%) had Child C cirrhosis, 13 patients (17.5%) had Child B cirrhosis and 14 (18.9%) patients had Child A cirrhosis. Haemoglobin on admission averaged 7.3±1.4 g/dl.All patients underwent early oesogastroduodenal fibroscopy after stabilisation of haemodynamic status: oesophageal varices were classified as stage II in 12 (16%) of patients, stage III in 28 (38%) and stage II in 12 (18%).patients (38%) and stage II-III in 34 patients (46%). Hypertensive gastropathy was found in 34 patients (46%) and red signs in 50 patients (67%). An associated peptic ulcer was found inassociated peptic ulcer was found in 3 patients (4%). In terms of treatment, all our patients received Sandostatin by auto-pulsed syringe for 5 days and antibiotic prophylaxis with IV ceftriaxone. 43% of patients received a blood transfusion.All patients were treated endoscopically: 70 patients (94.6%) underwent VO ligation by releasing an average of 4.4±1.5 elastics.on average. Primary haemostasis was achieved in 96% (71) of patients. Haemorrhagic recurrence was noted in 3 patients (4%), 2 of whom underwent subsequent endoscopic revision.

Conclusions Ligation of oesophageal varices combined with haemostatic medical treatment with sandostatin are effective in the management of upper gastrointestinal haemorrhage caused by rupture of oesophageal varices.