A case of an unusual hernia associated with gastrointestinal bleeding.
Overview
abstract
BACKGROUND: Acute upper gastrointestinal (GI) bleed is a well-known presentation to the emergency department (ED) frequently accompanied by hematemesis. We describe the case of a patient with abdominal content herniation into the chest wall with a recent history of coronary artery bypass graft presenting with acute onset of hematemesis. OBJECTIVES: To present an exceedingly rare herniation of abdominal contents into the chest wall that was accompanied by hematemesis and to present the rare visual findings inherent in this pathology. CASE REPORT: A 65-year-old man presented to the ED vomiting large amounts of blood upon presentation, compromising hemodynamic stability and prompting emergent resuscitation. The patient's presentation was complicated by a large 30 × 40-cm anterior chest wall mass extending 2 cm inferior to the sternal notch expanding with each episode of hematemesis. Computed tomography after stabilization revealed a large ventral hernia extending into the chest wall, containing small and large bowel. We suspected this large, unusual hernia to be the underlying cause of the patient's GI bleeding. CONCLUSION: The emergency physician must be able to assess hemodynamic stability of an upper GI bleed and resuscitate the unstable patient if warranted. Diagnosis is to be subsequently determined after stabilization.
