A 50 year old man presented with sudden abdominal pain, abdominal distension and shock. Atemergency laparotomy a large amount of blood was found in the peritoneal cavity. There wasmicronodular cirrhosis of the liver and the spleen was enlarged. The bleeding was traced to distendedveins in the right paracolic gutter which were oversewn and the abdomen closed. A coagulopathy wasdiagnosed and treatment including high dose aprotinin commenced. However, he continued to bleedand at a second laparotomy the area of previous haemorrhage was packed. Further deteriorationcontinued until death 12 hours later. Intraperitoneal haemorrhage from ectopic varices is a rareoccurrence. There is a high mortality rate usually due to an advanced coagulopathy. This is the firstreport of aprotinin being used in an attempt to treat this. On the basis of this report aprotinin would notseem to be of benefit for this condition.
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