Hemorragia digestiva obscura complicada de choque em Testemunha de Jeová

Abstract

The severe gastrointestinal bleeding in a Jehovah's Witness poses a clinical challenge in which deontological and legal ethical standards are in conflict with the need of an effective and fast‐acting therapeutic approach. We present a case of a Jehovah's Witness, with a written refusal of transfusions, admitted for obscure overt gastrointestinal bleeding and acute severe anemia. The hospitalization was complicated by severe haemorrhage (minimum haemoglobin 3.5 g/dL) and shock, without an identified etiology on upper gastrointestinal endoscopy and colonoscopy. An emergent angiography showed a contrast product leak in the jejunal branches of the superior mesenteric artery and a selective arterial embolization was performed. The clinical evolution was favorable, with progressive increase of the haemoglobin level. Jejunal angioectasias and aftoid erosions were observed in a videocapsule enteroscopy performed later. We discuss the ethical dilemma associated with this difficult clinical situation and present demonstrative iconography.