Successful Intraoperative Resuscitation following Upper Gastrointestinal Bleeding using the Retrograde Insertion of a Sengstaken-Blakemore Tube

We report the novel use of a Sengstaken-Blakemore tube in an 82-year-old man with severe upper gastrointestinal bleeding and subsequent hypovolemic shock. When exploratory laparotomy failed to locate the source of the bleeding, a Sengstaken-Blakemore tube was placed retrograde to the gastroesophageal junction using a previously inserted nasogastric tube for guidance. The bleeding stopped immediately after mechanical compression by the inflated gastric and esophageal balloons. Hemodynamic stability permitted a thorough evaluation of the surgical field. The balloons were deflated intermittently to allow the surgeon to address the major and other smaller bleeding vessels in a stepwise manner. The intraoperative insertion of a Sengstaken-Blakemore tube can be used to control disastrous upper gastrointestinal bleeding located at or above the gastroesophagealjunction. It helps to achieve hemodynamic stability with less transfusion required and results in fewer complications. However, the lack of experience with the direct placement of a Sengstaken-Blakemore tube and the need for the equipment-dependent confirmation of the SengstakenBlakemore tube position reduces its clinical usage. The retrograde Sengstaken-Blakemore tube insertion strategy does not require assistance by ultrasonography or endoscopy and avoids most procedure-related complications.