Breaking the Barrier: Understanding Esophageal Ruptures.

Esophageal rupture, though rare, presents as a critical medical emergency demanding swift recognition and intervention. This condition entails a breach in the integrity of the esophageal wall, leading to leakage of its contents into the mediastinum or surrounding structures. Its etiology often involves a combination of factors, including forceful vomiting, foreign body ingestion, or medical procedures like endoscopy. Timely diagnosis through imaging modalities like CT scans, contrast esophagography, or endoscopy is crucial for prompt management and favorable outcomes. Offering aggressive care in the setting of futile treatment for esophageal perforations raises several ethical, medical, and practical implications. If the prognosis is deemed futile due to factors such as extensive tissue damage, underlying comorbidities, or delayed presentation, aggressive care may only prolong suffering without meaningful improvement in outcomes. Opting for palliative measures in such cases focuses on enhancing the patient's quality of life and providing comfort rather than pursuing futile treatments.

Upper gastrointestinal bleeding from gastric antral vascular ectasia following cocaine use: case presentation and review of literature.

Gastric antral vascular ectasia (GAVE), also known as "Watermelon stomach", is a rare cause of upper gastrointestinal bleeding (UGIB). It is characterized by an endoscopic appearance of flat red blood vessels traveling from the pylorus to the antrum. Patients often present with chronic blood loss resulting in iron deficiency anemia, or, less commonly, with acute gastropathy resulting in massive hemorrhage. The etiology of GAVE is unknown but the disorder has been more commonly observed in patients with cirrhosis, especially with portal hypertension, as well as in those with systemic sclerosis and other connective tissue disease. There is no definitive cure for GAVE, but the condition can be managed with a variety of endoscopic techniques, including heater probes, bipolar probes, plasma coagulators, laser therapy, and radiofrequency ablation. In rare cases, patients also require blood transfusions. Here we present an interesting case of upper GI bleeding resulting in symptomatic anemia in a 69-year-old female patient with GAVE following cocaine use. The patient was initially admitted for fatigue and shortness of breath and required multiple units of pRBCs. She was also found to have a urine drug screen positive for cocaine. Following stabilization, she underwent endoscopy which revealed the characteristic "watermelon stomach" appearance consistent with GAVE syndrome. The patient was discharged on an oral proton-pump inhibitor with instructions to follow-up outpatient with Gastroenterology. This case is presented as an example of a risk factor for acute exacerbation of a rare cause of UGIB. This patient presentation also represents an example of the importance of strict follow-up for those with risk factors for exacerbation of chronic GI conditions.