Abstract:
Background
The use of various endoscopic techniques has progressively reduced the role of surgery in
the emergent management of UGm, under certain circumstances the surgeon, however
still plays an important role in the management and in a specific group of patients. The
problem poses a greater challenge to the surgeons in developing countries, Tanzania
being among them, where endoscopy may not be widely available.
Objective
To study the profile of patients with acute upper gastrointestinal bleeding as seen at
Muhimbili National Hospital.
Results
A total of 77 patients were studied. Males were approximately five times more frequently
involved as compared to females. Upper gastrointestinal endoscopy was done in 67
patients. Oesophageal varices were the leading cause of acute upper gastrointestinal
bleeding (48.1%) followed by duodenal ulcer (22.I%). Varices had a peak at the age of
31 to 50 years. Duodenal ulcer was commonest in patients who were above 50 years of
age, A palpable spleen positively predicted varices as a source of bleeding in 91.9% of
patients, while impalpable spleen predicted a source of bleeding other than varices in
96.7% of patients. The association between splenomegaly and varices was statistically
significant (P value < 0.00l). The mean number of units of blood transfused in these
patients with acute upper gastrointestinal bleeding was 2.9 +/- 2.5. Patients with varices
needed more blood transfusion than other causes. Mean hospital stay was 12.9 +I- 12.2.
Hospital stay was prolonged in patients with varices. Overall mortality due to acute upper
gastrointestinal bleeding was 15.6% Most deaths occurred in patients who had not
undergone upper GI Endoscopy due to haemodynamic instability.
Conclusion
In Tanzania, at ~, upper gastrointestinal bleeding was found to be five times more
common in males than females among patients admitted to hospital. Haematemesis
and/or melaena were the most common symptoms presenting in more than 90% of
patients. The majority of patients admitted with acute UGI bleeding had oesophageal
varices, most of whom were below 50 years. Splenomegaly is an important indicator for
varices. Patients with oesophageal varices had longer hospital stay and needed greater
number of units of blood transfusion.
