A 35 year old architect came to the Emergency Room by ambulance after unepectedly vomiting blood and passing out at work. From the great loss of blood, his blood pressure was very low and he was very anemic and weak. The ER doctors felt a bleeding peptic ulcer was likely the problem. To complicate the situation further, he was a Jehovah's Witness and refused a life-saving blood transfusion. He was too unstable for major surgery, so Dr. Fusco was asked to perform an emergency gastroscopy "scope" examination at the patient's bedside in the Intensive Care Unit. This exam correctly identified the problem as an unusual tumor in the wall of the stomach, not a peptic ulcer. The gastroscopy exam also helped stop the bleeding. During the test, Dr. Fusco passed a long thin needle through the scope and injected epinephrine (Adrenaline) solution directly into the center of the tumor. Epinephrine constricts blood vessels and helped slow the flow of blood. Then Dr. Fusco was able to successfully stop the bleeding by passing a special electric cautery probe through the scope and into the opening of the tumor. Once the bleeding stopped, the patient was able to undergo emergency surgery. At the time of surgery, a round firm tumor was removed from the wall of the stomach. It was analyzed in the pathology laboratory. The biopsy came back showing no cancer. This was an odd tumor called a leiomyoma, or tumor of the muscle wall of the stomach. The patient recovered quickly and was discharged from the hospital three days after surgery. He continues to do well and has had no more episodes of bleeding. Diagnosing the cause of bleeding from the stomach is a common indication for a gastroscopy examination. As in this case, the bleeding site can often be treated with the scope to stop the loss of blood.

Text & Images Courtesy of Three Rivers Endoscopy Center
© Dr. Robert Fusco, Three Rivers Endoscopy Center, All Rights Reserved