Extensive ulcerative duodenitis caused by ischemia

Upper Gastrointestinal Bleed Secondary to Duodenal Ischemia

We would like to present a rare case of postoperative duodenal ischemia managed conservatively. This is an 83-year-old female who underwent an elective costotransversectomy and discectomy. The surgery was complicated by hypotension. Postoperative recovery was complicated by episodes of diarrhea and melena with a hemoglobin drop. Esophagogastroduodenoscopy (EGD) performed revealed diffusely ischemic duodenal mucosa affecting both the first and second parts. Computed tomography angiography failed to find occlusion of blood supply. The patient was managed conservatively with fluids and hemodynamic support. The blood supply to the duodenum is highly collateral making ischemia here rare. In similar case reports of successfully conservatively managed duodenal ischemia, EGD was also performed due to similar rare presentations and diagnostic challenges/uncertainties, despite EGD currently not being considered a useful adjunct in the diagnosis of acute mesenteric ischemia. They were also managed conservatively with fluid replacement, bowel reset, and proper selection of current medications.