KẾT QUẢ PHẪU THUẬT VÀ ĐIỀU TRỊ XUẤT HUYẾT TIÊU HÓA NẶNG - SỐC MẤT MÁU DO UNG THƯ DẠ DÀY TRÊN BỆNH NHÂN ĐÔNG MÁU RẢI RÁC TRONG LÒNG MẠCH (DIC

Abstract

Study aim: Retrospective study aimed at evaluate the clinical feature, surgical result and resuscitation of blood loss shock patient  due to bleeding gastriccancer associated with  Disseminated Intravascular Coagulation (DIC). Medical record: Young female aged of 25 year olds, emergency hospitalization due to fever 39 degrees C with melena. Gastroscopy revealed gastric ulcer 3 cm in diameter (forrest II b). The 2nd gastroscopy (after 2 days) showed  gastric ulcer 3 cm in diameter with bright blood (Forrest IB).Symptoms: Hematemesis and melena (hemachezia), Pulse rate 120-130 beat/m, Bloosd pressure 80-90 mg hg. red blood cell count: 2,45 T/L, Hemoglobin 5,9 g/L,hematocrite 0,18L/L, platelet 94G/L;  white blood cell counts 12,54 G/L;.CTScan revealed lymph-node at superior mesenteric artery, aortic artery. Emmergency opreration, Intra opreration lesion: Gastrictumor bleeding located at smaller curve of stomach measured 3-4 cm. Operation performed: Subtotal gastrectomy with DII lymphadenectomy. Histopathology: AC poor diferentiated T4N3 Mo, 13 node (+). Post operation at ICU. D Dimer raiseed, platelet reduced, SpO2 60%, reintubation, patient dyed of pulmonary thombosis Conclusion: We concluded that Bleeding gastriccance, vascular lesions in cancerous ulcer and sepsis could be main factors trigger and activate Disseminated Intravascular Coagulation (DIC). It is better to have done gastrectomy earlier to eliminate bleeding gastriccancer (the main factor to trigger DIC). Emmergency surgical procedure in blood loss shock patient in association with DIC could have bad resuls.