Vena caval penetration by gastric ulcer: massive hemorrhage and embolization of gastric contents to lungs.

A 54-year-old man who died from acute upper gastrointestinal blood loss was found on postmortem examination to have a large amount of blood in the intestinal lumen from perforation of a gastric ulcer into the inferior vena cava. Gastric contents had also embolized into the pulmonary circulation. Most of the stomach was located posteriorly in the right thoracic cavity because of prior esophageal surgery, which had brought the posterior wall of the stomach in apposition to the anterior wall of the inferior vena cava. This is thought to be the first report of a gastric ulcer forming a fistula into the inferior vena cava, with food embolization to the lung.