Systemic Signs of an Unexpected Guest in a Case of Apparent Upper Gastrointestinal Bleeding Leading to an Endoscopic Extraction of a Foreign Body: A Case Report

Abstract

Background and Clinical Significance: Upper gastrointestinal (GI) bleeding is a common emergency, typically requiring prompt intervention. This case report presents a unique situation where apparent GI bleeding was ultimately identified as anaphylaxis triggered by accidental wasp ingestion. Such cases are rare, underscoring the need for a broad differential diagnosis in atypical presentations. Case Presentation: A 53-year-old male with a history of heavy alcohol use presented with presumed acute hematemesis, hypotension, and tachycardia. An initial examination revealed mild anemia and elevated liver enzymes. An urgent upper GI endoscopy showed severe esophagitis with no signs of active or stigmata of recent bleeding; instead, two dead wasps were found in the gastric antrum. Further inquiry revealed that the patient had recently consumed a home-brewed alcoholic beverage, likely contaminated with the wasps. The patient's symptoms were then attributed to anaphylaxis from venom exposure rather than hemorrhagic shock. The patient's condition improved with antihistaminic therapy, and he was discharged with follow-up recommendations. Conclusions: This case highlights the importance of considering rare but critical diagnoses, such as insect-induced anaphylaxis, in patients presenting with presumed GI bleeding. It reinforces the value of thorough history taking, prompt endoscopy, and systematic management in assessing and treating atypical emergency presentations.

Keywords: anaphylaxis; endoscopy; foreign body; hymenoptera venom allergy; upper gastrointestinal bleeding.

Figure 1

The endoscopic view of the gastric antrum, revealing the wasps, highlighted with a black arrow.

Figure 2

The endoscopic retrieval net is designed as a disposable snare with a tear-proof perforated extraction bag with a snare opening of 20–30 mm.

Figure 3

The wasp retrieved using the endoscopic retrieval net.