A 25-year-old man is involved in an automobile accident with resultant injuries including bilateral closed femur fractures, left pulmonary contusion, and closed head injury. On post-injury day 4, significant upper gastrointestinal hemorrhage begins. Endoscopic examination reveals an area of confluent ulceration with bleeding in the gastric fundus. Endoscopic hemostasis fails. Appropriate immediate management includes:
A. Lavage of gastric contents with iced saline
B. Urgent total gastrectomy
C. Selective arterial infusion of vasopressin via the left gastric artery
D. Insertion of Sangstaken-Blakemore balloon
Answer:C
A 25-year-old man is involved in an automobile accident with resultant injuries including bilateral closed femur fractures, left pulmonary contusion, and closed head injury. On post-injury day 4, significant upper gastrointestinal hemorrhage begins. Endoscopic examination reveals an area of confluent ulceration with bleeding in the gastric fundus. Endoscopic hemostasis fails. Appropriate immediate management includes:
A. Lavage of gastric contents with iced saline B. Urgent total gastrectomy C. Selective arterial infusion of vasopressin via the left gastric artery D. Insertion of Sangstaken-Blakemore balloon