Risk stratifying patients with non-varicosic upper gastrointestinal hemorrhage using the Glasgow-Blatchford score: A case series of 91 patients.

Introduction: Non-variceal upper gastrointestinal hemorrhage (NVUGIH) often leads to systematic hospitalization and emergency endoscopy. However, in most cases, it does not constitute an immediate life threat. This study aimed to evaluate the Glasgow-Blatchford Score (GBS) in predicting the need for transfusions, and/or endoscopic or surgical treatments. Materials and methods: We conducted a retrospective monocentric study including 91 patients admitted in the general surgery department of the Hospital La Rabta Tunis for a NVUGIH.Univariate analysis was performed with the Student t-test for continuous variables and with the Chi-square test for categorical variables. For a cut-off point of 9, we calculated the sensibility and the sensitivity of the GBS to predict the need for transfusions and/or hemostatic procedure. Results: During the study period, 91 patients were admitted for NVUGIH. Sixty-one patients (67%) were transfused. Seven patients (7.7%) underwent emergency surgery and two patients had endoscopic hemostasis.The predictive factors for the use of transfusion and/or hemostasic treatments were: Age >50 years, ASA score, HR ≥ 90 bpm, pallor, Hb ≤ 9,5 g/dl, Urea ≥9,7 mmol/L.For a cut-off of 9 points of the GBS, sensitivity was 85.71% and specificity 92.86%. The positive predictive value was 96%. The negative predictive value was 74%. Conclusion: The main interest of the GBS lies in dispatching the patients between intensive care units for therapeutic intervention (if GBS> = 9) and ordinary hospitalization for surveillance (if GBS <9). It then makes it possible to rationalize the management of patients with digestive hemorrhage to identify those requiring hospital treatments (transfusion, endoscopic treatment, or surgery).

Primary duodenal tuberculosis complicated with perforation: A review of literature and case report.

Tuberculous (TB) disease remains an endemic pathology in Tunisia. the ileocecal region is the predominant site of involvement while gastroduodenal tuberculosis is very rare, this form is often presenting as one of the complications, mainly upper gastrointestinal stenosis or exceptionally as a perforation. We describe a case of female patient aged 33 years-old presented with a 2-day history of acute abdominal pain, with a tenderness of the right hypochondrium and the epigastrium, ultrasound of the abdomen revealed gallbladder distension with a wall thickening. The diagnosis of acute cholecystitis was suspected and the patient had an exploratory laparoscopy that revealed the presence of a perforated duodenal ulcer which was blocked by the gallbladder and several peri-duodenal lymph nodes. Cholecystectomy was performed and the edges of the ulcer were resected and the ulcer was sutured. Histological examination revealed duodenal tuberculosis and the patient was referred to the TB eradication program.