Rare causes of acute non-variceal gastrointestinal bleeding episodes: results of endoscopic therapy.

In this study the frequency of rare causes of acute upper gastrointestinal bleeding was studied retrospectively using the case load of a large teaching hospital. Nine hundred and eighty patients with a clinical diagnosis of upper gastrointestinal bleeding were endoscoped between November 1987 and February 1993. Of these, 156 patients were found to be actively bleeding or had a visible vessel. Rare causes of bleeding were identified in 11 patients (7%). A Dieulafoy ulcer was found in five cases, and a mesenchymal tumor of the stomach in three patients. In the three remaining patients a bleeding gastric polyp, hemobilia and ischemic necrosis of the small bowel were identified as the source of bleeding. In three of these 11 patients the diagnosis was delayed and only made on repeat endoscopy the following day. Therapeutic endoscopy with circumlesional injection of epinephrine was successful in the majority of patients, and only three patients underwent emergency surgery. Two patients died during the acute bleeding episode, one of them had a Dieulafoy ulcer, the other suffered from ischemic bowel necrosis. Diagnosis of rare causes of acute upper gastrointestinal bleeding may be delayed, morbidity and mortality increased. Familiarity with these conditions may improve the outcome.