Severe Epistaxis - Case Study (1 of 8)

A 76 year-old female that one month previously was hospitalized due to severe epistaxis in a hospital of the Social Insurance of El Salvador, had been treated with repeated anteroposterior nasal packing, presented significant secondary anemia. Patient does not accept sanguineous transfusions due to religious rules. Three years earlier, we had practiced an upper endoscopy and a colonoscopy, both were negative. Due to generalized weakness, edema and anemia (with Hb. 6.2 mg/dl) she was hospitalized. 2 days later she initiates with multiple melenas, the clinical picture was of severe bleeding of the upper digestive tract, nevertheless gastric lavage with nasogastric tube was negative to bled, the next day the hemoglobin falls to 3.2 mg/dl, an upper endoscopy did not find any pathological site that bled.