• Jad Z Bou-Abdallah, Uma K Murthy, Nilish Mehta, Heramba N Prasad, and Vivek Kaul.
• Department of Internal Medicine, State University of New York Upstate Medical University and VA Medical Center, Syracuse, New York, USA.
• J Emerg Med. 2012 Jul 1;43(1):44-6.

BackgroundAcute upper gastrointestinal (UGI) bleeding manifests as hematemesis, melena, or hematochezia. Initial management is identical, irrespective of nasogastric (NG) aspirate results. Current practice includes early upper endoscopy. Significantly fewer high-risk bleeding lesions are found on endoscopy in patients with coffee grounds vs. bloody NG aspirates.ObjectiveWe present a case series to illustrate that patients with coffee grounds emesis (CGE) often have other unsuspected illnesses that may be overlooked due to preoccupation with the GI bleed.Case ReportsA retrospective chart review of a series of 6 patients presenting with CGE and admitted for upper GI bleeding was performed. All 6 patients were hemodynamically stable at admission. NG lavage showed coffee grounds that cleared easily. None of the patients required blood transfusions during their hospital stay. Endoscopy in 3 of 6 patients failed to find any significant UGI lesions or stigmata of recent bleed.ConclusionAlthough patients were admitted for UGI bleeding, the more significant associated diagnoses included acute myocardial infarction, urosepsis, small bowel obstruction, bilateral pulmonary emboli, and acute renal failure. Hemodynamically stable patients presenting with coffee grounds NG aspirate and no fall in hemoglobin/hematocrit should be evaluated for other non-GI bleeding-related conditions even as the GI bleed is being managed.Copyright © 2012 Elsevier Inc. All rights reserved.

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