26/10/2025
Real case
Acute Upper GI Bleeding in a Patient with Oesophageal Cancer
Background:
An elderly gentleman with a known diagnosis of oesophageal carcinoma, previously managed with oesophageal stent insertion, presented with acute upper gastrointestinal bleeding.
Presentation:
The patient was initially found hypertensive but clinically unwell, and soon deteriorated towards pre-arrest condition. Active upper GI bleeding was suspected.
Immediate Management:
The resuscitation team was activated immediately. Intravenous access was secured with wide-bore cannulas, and fluid and blood product resuscitation were initiated as per major haemorrhage protocol. The resources and theatre team were mobilised promptly, with the emergency endoscopy team attending without delay.
Intervention:
The patient was transferred urgently to the endoscopy theatre for emergency upper GI endoscopy, which confirmed the source of bleeding from the stented oesophageal tumour. Endoscopic haemostasis was performed with supportive critical care input.
Outcome:
The patient stabilised following endoscopic intervention and ongoing resuscitation. He was transferred to the high dependency unit for post-procedure monitoring and further oncological planning.
Reflection:
This case highlights the importance of rapid recognition, early activation of the major haemorrhage protocol, and team coordination between surgical, anaesthetic, and endoscopic services in managing acute upper GI bleeding, particularly in patients with known oesophageal malignancy.
