Abstract

Upper gastro intestinal bleeding is a common presentation to the Emergency Department; aproportion of these bleeds are secondary to duodenal ulcers. The management of thesein young, fit patients who can tolerate a second bleed physiologically is well established. However in the elderly frail patient a second bleed may be terminal. Options for treatment for these blee ding duodenal ulcers (apart from resuscitation, including transfusion if need be and medical management with intra venous Proton Pump Inhibitors), include endoscopic control, laparotomy with under running of the bleeding artery and endovascular approaches. 98 percent of patients can be successfully managed with endoscopy and epinephrine injection, coagulation and / or clipping of the bleeder. The dilemma exists in those patients whom are high risk for surgical intervention (laparotomy) should a re-bleed occur. In these patients transcatheter arterial embolization has become a favourable treatment modality and especially in high risk patients, selective transcatheterembolisationhas been established as a safe approach (1,2,3,5,9). In this case report we discuss the management of a 98 year old male with a duodenal ulcer with stigmata of recent bleed who presented to our department in a rural setting in Victoria, Australia.