OSTEOMYELITIS AND BONE-MARROW APLASIA AFTER GASTROSCOPY

Severe bleedings and infections following gastroscopy may lead to life threatening complications. A 56-year-old patient underwent a Billroth-II gastrectomy because of gastric cancer. Following endoscopic removal of a biopsy acute upper gastrointestinal bleeding occurred which ceased after administration of fresh-frozen plasma and >>prothrombin complex<<. The following day she developed a septic shock with disseminated intravascular coagulation and neurological symptoms. In the bone marrow aspirate Escherichia coli could be identified. The radionuclide bone- and marrow scan revealed a generalized osteomyelitis and an extensive extramedullary hematopoiesis. High-dose triple antibiotic therapy provided temporary relief of the clinical symptoms. Four weeks later she developed multiple fractures of the thoracic vertebral bodies, ilium and ischium. A type-IV bone-marrow aplasia developed with insufficient hematopoiesis. The patient died as a result of the osteomyelitis and aplasia. Bacteriological examination of the gastric contents was not performed in order to proof the focus. The short-time interval relating to the bleeding event, the E. coli sepsis and no evidence for another cause of the bacteremia makes the biopsy as the original focus more likely. Consequently, antibiotic prophylaxis should be administered in high-risk patients with valvular heart disease and should also be considered in patients with compromised defense.