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A rare cause of upper GI bleeding and wasting disease
  1. Rene J van Erp1,
  2. Bernd Schröppel1,
  3. Thomas F Barth2,
  4. Thomas Seufferlein1,
  5. Stefan A Schmidt3,
  6. Alexander Meining1,
  7. Alexander Kleger1
  1. 1Department of Internal Medicine I, Ulm University, Ulm, Germany
  2. 2Institute of Pathology, Ulm University, Ulm, Germany
  3. 3Department of Diagnostic and Interventional Radiology, Ulm University, Ulm, Germany
  1. Correspondence to Dr Alexander Kleger, Department of Internal Medicine I, Ulm University, Albert-Einstein-Allee 23, Ulm 89081, Germany; alexander.kleger{at}uni-ulm.de

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Clinical presentation

A 74-year-old Turkish woman was admitted with loss of appetite, weight loss and progressive anaemia. Her medical history included rheumatoid arthritis, type 2 diabetes and end-stage renal disease with nephrotic syndrome diagnosed 2 years ago. Endoscopy of the upper GI tract revealed a distinct intramural gastric haematoma with diffuse, seeping haemorrhage and large gastric intraluminal blood clots (figure 1A, B; online supplementary films 1 and 2). The mucosa appeared partly necrotic, and the gastric wall showed a sponge-like consistence and marked vulnerability. An abdominal CT scan was performed.

Figure 1

Endoscopic and radiological imaging. (A and B) Intraluminal view of the patient’s stomach during gastroscopy shows large blood clots and reveals a sponge-like consistence and marked vulnerability on biopsies. (C …

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