An Unusual Presentation of Gastric Variceal Hemorrhage

Acute upper gastrointestinal (GI) bleeding is a commonly encountered condition that can potentially be life-threatening. Endoscopy is the diagnostic modality of choice, but it is important to recognize it's shortcomings. We introduce a 61-year-old female who presented with hematemesis and syncope. She had a history of recurrent episodes of hematemesis and hospitalizations for the preceding 18 months, for which multiple endoscopies had been performed but had failed to demonstrate a source. A repeat esophagogastroduodenoscopy (EGD) performed at our facility was unremarkable. A CT scan demonstrated a lobulated mass-like filling defect in the gastric cardia consistent with solitary varix with an abnormal fold pattern. An upper GI follow-through series was performed to better characterize this varix. The patient subsequently underwent balloon-occluded retrograde transvenous obliteration with successful control of the source of bleeding. It is important to keep in mind that EGD while being the gold standard for the diagnosis of varices, has its limitations, and should be augmented with the use of non-traditional diagnostic modalities such as CT scans or radionuclide imaging.