F Soto, A Abdemur, I Fendrich, S Szomstein, R J Rosenthal. Cleveland Clinic Florida
Introduction: We report the case of a patient with new onset of severe gastrointestinal bleeding from intragastric metastasis of a renal cell carcinoma.
Case presentation and Methods: This is an 80-year-old male diagnosed with metastatic renal carcinoma in July 2009. He had a prior history of a craniotomy for drainage of a subdural hematoma a month after diagnosis and was admitted in November 2009 due to a massive GI bleed requiring over 6 units of blood. Endoscopy showed three large polypoid masses ranging from 3-5cm in the gastric cardia, body, and proximal antrum of stomach consistent with metastatic renal cancer. The two proximal lesions were oozing and treated with the APC at 40 watts and 1.2 litters of flow. He continued to bleed and a surgical consult was obtained. This unusual presentation of a gastrointestinal bleeding was managed with a combination of endoscopic guided laparoscopic wedge resection of the metastatic gastric tumors that resulted in complete resolution of the bleeding episode. The postoperative period was uneventful and the patient was discharged home on postoperative day 3, tolerating a regular diet.
Conclusion: Endoscopic guided laparoscopic resection of bleeding intragastric neoplasms appears to be feasible treatment alternative when endoscopic techniques have failed to control gastrointestinal bleeding episodes.
Program Number: V076