Abstract
A 59-year-old man was admitted with sepsis of unknown origin. He had been using NSAIDs for a long time. Abdominal CT showed small bowel distention and an irregular high-density area in the ileocecal region. On hospital day 6, he developed hemorrhagic shock due to lower gastrointestinal bleeding. Endoscopic examinations showed the possibility of NSAIDs-related ulcers and hemostasis was attempted, but multiple lesions were suspected and anemia worsened. On day 11, he underwent ileocecal resection without reconstruction, followed to intraoperative endoscopy and open abdomen management. Multiple ulcers were identified in the end of ileum. Anemia still progressed postoperatively, so partial resection of the jejunum without reconstruction was performed, followed by intraoperative endoscopy and open abdomen management on day 13. His general condition improved and enteral anastomosis was performed on day 16. On day 18, the abdominal wound was closed and postoperative condition was good. Lower gastrointestinal bleeding might occur with NSAIDs use and can involve multiple lesions. Single operations risk overlooking other lesions or resulting in excessive enteral resection. Open abdomen management and multi-stage surgery represents a good strategy for lower gastrointestinal bleeding with multiple lesions.
