Massive gastrointestinal haemorrhage due to gastritis cystica profunda

Abstract

Introduction: Gastritis Cystica Profunda is a well recognized entity which may occur several years after previous gastric surgery. This is a premalignant condition and may lead on to carcinoma of the stomach.

Case presentation: We report a case of a 50-year-old man with epigastric pain and haematemesis. 28 years ago he had undergone partial gastrectomy and gastroenterostomy for benign gastric ulcer. An Upper gastrointestinal endoscopy showed a possible bleeding vessel on the anterior wall lesser curve of the stomach. The lesion was injected with adrenaline 1 in 100,000. In spite of the intervention he continued to have haemetemesis with significant haemodynamic impairment. At exploratory laparotomy, an oedematous ridge on the posterior wall with a bleeding point on the posterior gastric wall. Histology showed features consistent with gastritis cystica profunda. He made an excellent post-operative recovery.

Conclusion: We suggest that patients who are diagnosed with gastritis cystica profunda should be regularly followed up as this is a premalignant condition.

Figure 1

Histology showing features of gastritis cystica profunda: Widespread disruption of the muscularis mucosa. The sub mucosa contained numerous glandular structures, lined mainly by antral-type gastric mucosa, showing marked cystic dilatation.