ACUTE UPPER GASTROINTESTINAL HAEMORRHAGE CAUSED BY NON-CIRRHOTIC GASTRIC VARICES BLEEDING IN A PATIENT WITH ANTIPHOSPHOLIPID SYNDROME : A CASE REPORT

Abstract

Background: Gastric varices are intricate vascular connections linking the portosplenic venous circulation with systemic abdominal and thoracic veins. Gastric varices tend to bleed more massively and are more difficult to control endoscopically than oesophageal varices. They have a higher rebleeding and mortality risk. The management is also more complex, often requiring combined approaches such as endoscopic therapy, radiologic interventions, vasoactive agents, and sometimes shunt procedures. The hemodynamic instability in acute bleeding, coagulopathy, and portal hypertension could also complicate resuscitation and therapeutic options. In this report we describe a case of a woman, previously diagnosed with Antiphospholipid Syndrome (APS), presented with acute upper gastrointestinal haemorrhage caused by non-cirrhotic gastric varices bleeding. Case presentation: a 37-year-old female patient was admitted to the Emergency Department with the primary complaint of hematemesis. She has a history of Antiphospholipid Syndrome 3 years prior and was given anticoagulant therapy but she didn’t continue the therapy. The contrast CT of the abdomen showed that there was a thrombus within the main portal vein. She was given packed red cells transfusion and later underwent esophagogastroduodenoscopy (EGD). The EGD result showed that she had oesophagus varices grade 1 and gastric varices GOV 2. The gastric varices GOV 2 was treated with cyanoacrylate glue injection to stop the bleeding. After she was stabilized, she was given warfarin to continue the anticoagulant therapy. Conclusion: Antiphospholipid syndrome can cause a hypercoagulable state and portal vein thrombosis which later present as gastric varices bleeding and needs a careful treatment approach