When Uncommon Turns Severe: Massive Gastrointestinal Bleeding in Gastric Hyperplastic Polyps

Massive Gastrointestinal Bleeding in Gastric Hyperplastic Polyps

Abstract

A 58-year-old woman with a medical history of alcohol use disorder presented with hematemesis. She was admitted to the intensive care unit (ICU) after she was found to have a hemoglobin level of 3 gm/dl and an INR of 1.7. She required transfusion of 5 units of PRBCs and 1 unit of fresh frozen plasma. Urgent esophagogastroduodenoscopy (EGD) showed (figures) two 25-35 mm multi-lobulated polyps with stigmata of recent bleeding at the gastroesophageal junction. Histopathology was consistent with hyperplastic polyps. Polyp resection was deferred to be done by advanced endoscopy team. She was treated for alcoholic hepatitis and acute kidney injury in the medical floor and several days later, she had sudden-onset bouts of hematemesis resulting in hemorrhagic shock and transfer back to the ICU. Repeat EGD showed two 25-35 mm pedunculated bleeding polyps at the gastroesophageal junction. Bleeding was controlled by epinephrine, and hemostatic clips placed along each polyp's stalk. She had ongoing bleeding after EGD, thus left gastric artery embolization was performed by interventional radiology. After the procedure, she remained hypotensive with worsening acute kidney injury.  As a result, she required continuous renal replacement therapy, vasopressor support and prolonged ICU stay where she passed away within the next few days due to multiorgan failure.