Inferolateral ST-segment elevation associated with a gastric variceal bleed and the use of a Minnesota tube

The use of Minnesota and modified Sengstaken-Blakemore tubes for balloon tamponade in acute variceal haemorrhage has declined with the availability of modern endoscopic techniques. However, in massive uncontrolled haemorrhage their use may still be required. They are very effective in controlling acute bleeding, but are associated with a range of potentially serious complications. This case demonstrates an unusual complication of the use of a Minnesota tube in a gentleman with a large gastric variceal bleed. The patient developed inferolateral ST-segment elevation on a 12-lead ECG which resolved rapidly following aspiration of 2000 mL of blood from the gastric port of the Minnesota tube. It was thought that the distension of the stomach, along with the traction applied to the Minnesota tube, resulted in external compression of the diaphragmatic surface of the heart and the observed ECG changes.