case of hemorrhage

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Posted by prateek from IP on May 17, 2013 at 00:22:48:

61 year old being treated for DU endoscopically begins to hemorrhage while in the endoscopy suite.
BP decrease to 60mm systolic.
A cental IV cathetar is inserted to resuscitate.
Emergency laprotomy is scheduled and he need 6 units of blood while the OR is being prepared.
Patient needs a further 6 units of packed red cells intraoperatively.
Bleeding is controlled.
He undergoes vagotomy and pyloroplasty.
Post op hb is 8.7md/dl
hct is 25%
second postop day urine output is 400cc over 24 hours.
BUN and creatinin are increased to 30 and 1.9
urine no casts or cells

which is the most likely explanation:
a chronic transfusion reaction
b myoglobinuria
c renal hypoperfusion
d intraoperative urethral injury
e sepsis

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