One day, I was called to the hospital to see a female patient in her seventies. She had been admitted after vomiting a significant amount of blood. This lady did not suffer from any chronic diseases, except for osteoarthritis in her knees, which forced her to take painkillers for long periods to manage the pain and maintain her mobility.
When I arrived at the hospital and met the patient in her room, she appeared to be in good general health, except for noticeable paleness in her skin due to blood loss. She was not suffering from any abdominal pain or any other symptoms. The medical team had already begun treating the patient, specifically by performing a blood transfusion.
By the next day, her hemoglobin levels had risen after the transfusion, which allowed us to proceed with an upper gastrointestinal (GI) endoscopy. A GI endoscopy is considered the most important tool for determining the source of bleeding in such cases.
The Procedure
Arrangement was made for an urgent endoscopy. The patient was brought to the endoscopy room, accompanied by the nursing staff and the anesthesiologist. The patient was calm and complained of nothing. The anesthesiologist administered the intravenous sedative, and the patient gradually lost consciousness. After a few seconds, the anesthesiologist gave me the signal to begin.
I started inserting the endoscope gradually through the patient’s mouth. In my mind, I expected the cause of the bleeding to be a simple ulcer, gastritis, or perhaps esophageal varices, and that the matter would be quite routine—treated with medication like many similar cases we see regularly.
The Shocking Discovery
However, as soon as the scope entered the stomach, I saw a sight I had never seen before. It was a very large gastric ulcer with a big perforation in its center. This hole made the stomach cavity continuous with the abdominal cavity, meaning that water or food could exit the stomach directly into the abdomen.
I saw no blood because the bleeding had already ceased after the patient received treatment. The result of the endoscopic examination was a large ulcer and a big perforation in the gastric wall.
But why didn’t the patient feel any pain until the ulcer reached this size and the perforation became this wide?
The Hidden Cause
The reason was that she was taking a painkiller to relieve her knee pain. These medications, specifically NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), can cause ulcers and inflammation in the digestive system with prolonged use. In many cases, they cause a perforation in the wall of the duodenum or the stomach.
This is exactly what happened to this patient. There was no pain despite the size of the ulcer because the painkillers she was taking masked it. More importantly, the large perforation allows stomach acid to leak into the abdominal cavity, which usually causes excruciating pain, but the effect of the painkillers played a role in preventing that sensation.
Emergency Intervention
After finishing the endoscopy, I immediately informed the surgical team of the results. They, in turn, decided to perform an emergency surgery to repair the perforation and save the patient’s life from peritonitis (inflammation of the peritoneal lining), which is considered a very serious and life-threatening condition.
After the surgery, the patient recovered quickly and was discharged from the hospital in good health.
The Lesson
The purpose of sharing this patient’s experience is to shed light on the danger of taking painkillers without medical supervision. This is just one of many complications they can cause. They don’t just affect the digestive system; they can also lead to complications in the kidneys, heart, liver, and many other issues.
This patient’s case is a typical example of how serious things can get.
