Complications
Abdominal pain lasting 10-15 minutes after vasopressin infusion may occur.
Rebleeding usually occurs within the first 24 hours and most often in patients with risk factors. Bleeding after endoscopic therapy is rare. Most cases of rebleeding have been described in older women with hiatus hernia.
Usually related to the acuity and severity of bleeding, and associated coronary artery disease.
Myocardial ischemia/infarct may be a concern in a patient with atypical chest pain and a history of coronary artery disease. Cardiac enzymes (creatine kinase [CK], CK-MB, and troponin) and ECG monitoring may be helpful in this situation.
Has been described during endoscopic epinephrine injection.[100]
Has been described during endoscopic epinephrine injection.[100]
Usually related to acuity and severity of bleeding; however, rare in patients with early stabilization and prompt treatment.
Esophageal perforation carries a high mortality secondary to rapidly developing mediastinitis and sepsis. It should be suspected in patients with retrosternal or epigastric pain with interscapular radiation, dyspnea, cyanosis, and fever.
Conventional radiology may be the initial test in order to diagnose esophageal perforation. If perforation rather than tear is suspected due to subcutaneous emphysema or crepitus, a computed tomography (CT) chest or contrast study is indicated to confirm and localize the level of perforation.[46] The CT chest may reveal extraluminal air and a site of perforation, if present. Survival improves dramatically if the injury is recognized and treated within 24 hours.
During vasopressin infusion the catheter tip may dislodge and enter a small vessel, which can result in ischemia or infarction. To avoid this, catheter tips should be assessed constantly.
Initial electrolyte evaluation and rapid replacement is imperative in patients with intractable vomiting.
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