Difficulties in differential diagnosis of gastric neoplasms

One of the most common causes of upper gastrointestinal bleeding is ulcers of the stomach and duodenum, accounting for about 50% of all cases. Meanwhile, the frequency of bleeding from varicose veins of the stomach averages around 4% per year. The main factor in the development of gastric varices is portal hypertension. In cases where the etiological factor for splenic vein thrombosis is not identified, even after thorough examination of the patient, the term “idiopathic” thrombosis is used. The prevalence of patients with this pathology can reach up to 50% of all cases. Objective of the study. To improve the effectiveness of diagnosing gastric tumors complicated by bleeding. Case description. Patient A., born in 1968, was urgently admitted for inpatient treatment to the Regional Clinical Hospital No. 2 in Krasnodar on April 30, 2024, with a clinical presentation of gastrointestinal bleeding from a gastric tumor. Results. On March 1, 2024, an esophagogastroduodenoscopy (EGDS) was performed at the outpatient clinic, which revealed an infiltrative-ulcerative formation at the bottom of the stomach; due to technical reasons, a biopsy was not taken. A repeat EGDS was recommended for morphological verification of the tumor. On April 15, 2024, a repeat EGDS was performed at the outpatient clinic with biopsy samples taken from the pathological area, after which the patient reported vomiting with blood streaks and hematochezia. On April 30, 2024, another EGDS was conducted at Regional Clinical Hospital No. 2, which showed contents in the gastric lumen mixed with fresh blood, and in the area of the gastric fundus—an isolated varicose vein protruding into the lumen up to 30 mm, with its mucosa exhibiting isolated “stigmata.” The patient was prepared for surgery. A median laparotomy was performed. Upon revision, enlarged gastric arteries resembling “snake entanglement” were noted. The spleen was enlarged, measuring 7.0 × 24.0 × 21.0 cm. A splenectomy was performed. Conclusions. Addressing the clinical problem of bleeding from gastric varices requires coordinated actions from physicians of various specialties: hepatologists, endoscopists, and surgeons. Continuous improvement of professional knowledge and practical skills among physicians will help save our patients’ lives.

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