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Clinical Medical
Image Library
ISSN: 2474-3682
IMAGE ARTICLE | VOLUME 2, ISSUE 1 | OPEN ACCESS DOI: 10.23937/2474-3682/1510023

An Uncommon Cause of Upper Gastrointestinal Bleeding

Michalis Galanopoulos1 and Apostolis Papaefthymiou2

1Department of Gastroenterology, Evangelismos general hospital, Greece

2401 Army General Hospital Athens, Greece

*Corresponding author: Michalis Galanopoulos, Department of Gastroenterology, Evangelismos General Hospital, Ypsilantou 45-47, 10676, kolonaki, Athens, Greece, Tel: 306-9366-19026; 3021-3204-1609, E-mail: galanopoulosdr@gmail.com

Published: January 23, 2016

Citation: Galanopoulos M, Papaefthymiou A (2016) An Uncommon Cause of Upper Gastrointestinal Bleeding. Clin Med Img Lib 2:023. doi.org/10.23937/2474-3682/1510023

Copyright: © 2016 Galanopoulos M, et al. This is an openaccess content distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Key words


Upper GI bleeding, Gastric tumors, Melena


Informed Consent


An informed consent was obtained from our patient.


Case Presentation


An 80-year-old man suffering from dementia and Parkinson disease was admitted to our hospital for investigation of 2 to 3 daily episodes of melena stools 20 days now. At his first presentation, he was hemodynamically stable and his initial hemoglobin was 10 g/dL (normal limits: 13-18). His past medical history was significant for weight loss (10 kg) and fatigue for the previous 3 months. There was no remarkable family history. The patient denied smoking, drinking alcohol, taking analgesics, or any other drug abuse (except for the dementia and the Parkinson disease), and his complete blood count revealed an iron-deficiency anemia.

During the upper GI endoscopy, we noticed to our surprise the presence of a sizable ulcerative lesion occupying the second half of body of the stomach on the lesser curve, exactly above the gastric angle (Figure 1), which was covered by a black-yellowish coating with irregular margins and with no active bleeding. Apart from this finding, nothing else was revealed. Biopsies were taken with great difficulty due to the hard consistency of the ulcerative margins of the lesion. The tissues were sent for histopathological evaluation which revealed a high-grade gastric adenocarcinoma.


Discussion


Gastric cancer accounts for 2-3% of all cases of severe upper gastrointestinal bleeding (UGIB) [1]. Patients with bleeding secondary to malignant upper gastrointestinal tumours have a poor prognosis [2]. Acute bleeding represents a late stage of disease when the tumour causes mucosal ulceration or erosion into an underlying vessel. Initial assessment and resuscitation should be performed according to the general guidelines for the management of UGIB. Endoscopy is critical for the diagnosis and primary treatment within 24 hours of presentation. Bleeding scoring systems, such as the Glasgow-Blatchford bleeding score (GBS) and the Rockall score, which evaluate clinical findings, and the Forrest classification of endoscopic images are helpful in managing tumor bleeding [3,4]. Endoscopic treatments for bleeding upper gastrointestinal tumours include injection therapy, thermal contact probes, Hemospay and laser therapy. Control of active bleeding can be successful, but rebleeding is common [5]. Surgical resection for cure or palliation is the final treatment of choice. Medical therapy is usually palliative and consists of chemotherapy and/or radiation therapy. In conclusion, although rare, a malignancy of stomach should be always considered in older patients presented with UGIB.

 

Figure 1: Endoscopic image, in retroflexion view, showing a large tumor on the lesser curve and posterior face, immediately above the gastric angle, confirmed on biopsies as a high- differentiated adenocarcinoma.

References


  1. Kim YI, Choi IJ (2015) Endoscopic management of tumor bleeding from inoperable gastric cancer.Clin Endosc 48: 121-127.

  2. Savides TJ, Jensen DM, Cohen J, Randall GM, Kovacs TO, et al. (1996) Severe upper gastrointestinal tumor bleeding: endoscopic findings, treatment, and outcome. Endoscopy 28: 244-248.

  3. Kim YI, Choi IJ, Cho SJ, Jong Yeul Lee, Chan Gyoo Kim, et al. (2014) Risk scoring systems in predicting intervention and clinical outcomes of bleeding in patients with unresectable gastric cancer. Gastrointest Endosc 79: AB298.

  4. Forrest JA, Finlayson ND, Shearman DJ (1974) Endoscopy in gastrointestinal bleeding.Lancet 2: 394-397.

  5. Sheibani S, Kim JJ, Chen B, Park S, Saberi B, et al. (2013) Natural history of acute upper GI bleeding due to tumours: short-term success and long-term recurrence with or without endoscopic therapy. Aliment Pharmacol Ther 38: 144-150.