Overt GI bleeding from a Cameron lesion in an Ethiopian with NSAID use: Case report of an unusual condition

INTRODUCTION: Cameron Lesions are linear breaks in the proximal gastric mucosa, mostly in association with hiatal hernia. The condition presents with chronic iron deficiency anemia and occasionally with obscure bleeding. Overt bleeding is very rare and has not been reported in sub- Saharan Africa context. CASE: A 78 year old male patient, with an already diagnosed hiatal hernia and gouty arthritis, presented with massive upper GI bleeding requiring resuscitation and blood transfusion. The patient was taking indomethacin for a gout flare prior to the episode and clinical suspicion was a peptic ulcer disease as the culprit for the bleeding. Endoscopy was done and it showed two linear erosions with recent bleeding in the hernia sac. No other bleeding source was identified. The patient was treated with a Proton Pump Inhibitor (PPI). DISCUSSION: Cameron lesions could present with massive bleeding and should be actively looked for in patients with hiatal hernia as they could be easily missed. Even with concurrent NSAID use, the condition could be a cause of major bleeding and careful evaluation is important. Management entails PPI therapy with occasional endoscopic intervention. CONCLUSION: In the setting of hiatal hernia, Cameron lesions should be actively looked for in patients presenting with overt GI bleeding.