An Atypical Case of Acute Upper Gastrointestinal Bleeding

Abstract

Question: A 62-year-old woman with recurrent intrahepatic cholangiocarcinoma 17 months after segment-oriented liver resection presented to the emergency department after 3 episodes of hematemesis over 4 hours. Symptoms appeared 1 month after radiofrequency tumor ablation. Physical examination revealed a soft, nondistended abdomen with a wellhealed surgical scar in the right upper quadrant and normoactive bowel sounds. There was no tenderness on palpation. Laboratory findings were notable, showing hematocrit and hemoglobin levels of 29.5% and 9.9 g/dL, respectively. Chest and plain abdominal radiography images (Figure A and B) were unremarkable. Esophagogastroduodenoscopy was performed immediately (Figure C), followed by abdominal computed tomography (Figures D and E).What could be the cause of hematemesis in this patient? What is the appropriate treatment?