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Teachable Moment
September 2015

Downstream Complications of Total Parenteral Nutrition—The Domino Effect: A Teachable Moment

Author Affiliations
  • 1Department of Internal Medicine, Carolinas Medical Center, Charlotte, North Carolina
JAMA Intern Med. 2015;175(9):1448-1449. doi:10.1001/jamainternmed.2015.2299

A woman in her 60s was admitted with epigastric pain, hematemesis, and acute anemia. Upper endoscopy revealed a large 25 × 30-mm nonobstructing gastric ulcer, several circumferential partially obstructing gastric ulcers at the pylorus, and small duodenal ulcers. The cause was attributed to nonsteroidal anti-inflammatory drugs (NSAIDs) because Helicobacter pylori pathology results were negative. The surgical consult recommended eventual vagotomy and antrectomy with reconstruction owing to the severity of the ulcers causing partial obstruction and the patient’s prior nonadherence to medical therapy.