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Life-Threatening Mallory-Weiss Tears: From Upper Gastrointestinal Bleed to Multisystem Crisis - A Case Report | ||
| Iranian Journal of Colorectal Research | ||
| دوره 13، شماره 4، اسفند 2025 اصل مقاله (656.91 K) | ||
| نوع مقاله: Case Report | ||
| شناسه دیجیتال (DOI): 10.30476/acrr.2026.109805.1278 | ||
| نویسندگان | ||
| Sahil C Sabharwal* 1؛ Brandyn Young2؛ Deepak Sabharwal3؛ Christopher Clark4؛ Robert Donnell4 | ||
| 1Department of Internal Medicine, University of Arkansas for Medical Sciences Northwest Regional Campus, Fayetteville, Arkansas, USA | ||
| 2College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA | ||
| 3Health Orlando Incorporated, Orlando, Florida, USA | ||
| 4Department of Internal Medicine, Mercy Hospital Northwest Arkansas, Rogers, Arkansas, USA | ||
| چکیده | ||
| Introduction: Hypoxic respiratory failure, defined as arterial oxygen tension (PaO₂) <60 mmHg on room air, is commonly caused by pulmonary conditions such as pneumonia, pulmonary embolism, or acute respiratory distress syndrome. Less frequently, systemic factors such as hemorrhagic shock can impair oxygen delivery due to severe anemia and reduced perfusion. Mallory-Weiss tears (MWTs) are longitudinal mucosal lacerations at the gastroesophageal junction, typically caused by vomiting or retching, and may result in significant upper gastrointestinal (GI) bleeding. Case Description: We report a case of an 81-year-old woman with gastroesophageal reflux disease and a prior cerebral infarct for which she was taking apixaban. She presented with stroke-like symptoms and became hypoxic en route to the hospital, requiring intubation. Laboratory evaluation revealed profound anemia (hemoglobin 2.8 g/dL), metabolic acidosis (pH 6.95, bicarbonate 8 mmol/L), and elevated lactic acid (8.1 mg/ dL). She received multiple blood products, reversal of anticoagulation, and supportive care in the intensive care unit. Initial imaging showed a hiatal hernia but no active bleeding. Nasogastric output demonstrated coffeeground material. Esophagogastroduodenoscopy on day 2 revealed an MWT. She was extubated on day 3 and discharged on day 11. Discussion: This case emphasizes the importance of considering non-pulmonary causes of hypoxia, particularly severe anemia from occult GI bleeding, even in the absence of overt signs. Hypoxia was primarily driven by reduced oxygen-carrying capacity rather than intrinsic lung pathology. Timely recognition, endoscopic diagnosis, hemostasis, and restoration of hemoglobin reversed respiratory compromise. Clinicians should maintain a high index of suspicion for occult bleeding in unexplained hypoxic respiratory failure. | ||
تازه های تحقیق | ||
Sahil Sabharwal (Google Scholar) | ||
| کلیدواژهها | ||
| Hypoxic respiratory failure؛ Mallory-Weiss tear؛ upper gastrointestinal bleeding؛ hemorrhagic shock؛ severe anemia؛ anticoagulation (apixaban)؛ esophagogastroduodenoscopy؛ older adult (geriatric) | ||
| مراجع | ||
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