TY - JOUR T1 - Marginal ulcer with erosion into splenic artery in a patient with a Roux-en-Y gastric bypass JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000784 VL - 6 IS - 1 SP - e000784 AU - Jennifer Silvis AU - Leah Aakjar AU - Jane Keating AU - Nicholas Costanzo AU - Pallavi Nadendla AU - Daniel Ricaurte Y1 - 2021/06/01 UR - http://tsaco.bmj.com/content/6/1/e000784.abstract N2 - A female patient in her 70s with a remote history of an open Roux-en-Y gastric bypass for weight loss was admitted to the medical intensive care unit (ICU) for septic arthritis of the hip and associated bacteremia. On hospital day 7, the patient was found to have a significant drop in hemoglobin to 55 g/L. Despite undergoing a CT angiography of the abdomen and pelvis, no source of bleeding was identified. She received two units of blood and responded appropriately. On hospital day 9, the patient4 began to experience melanic stools and hematemesis. At that time, she was found to have a hemoglobin of 40g/L, a base deficit of −15, and was requiring three vasopressors to maintain adequate blood pressure. Both acute care surgery as well as gastroenterology were emergently consulted. A femoral venous introducer was placed and a massive transfusion protocol (MTP) was initiated. The patient was intubated, and … ER -