Cameron Lesions - An Uncommon Cause of Overt Gastrointestinal Hemorrhage

Abstract

Cameron lesions are erosions or ulcerations commonly found in patients with hiatal hernias, which can lead to both chronic, and at times, life-threatening acute bleeding. Cameron lesions have been reported at a prevalence rate between 3.3 and 5.2% in patients with hiatal hernias undergoing esophagogastroduodenoscopy (EGD), however those without evidence of hiatal hernia on EGD still carry a risk of .66% (1, 2). These lesions can be inferred from a patient with a known diagnosis of hiatal hernia and a history of iron deficiency anemia, a positive fecal occult blood test or overt evidence of gastrointestinal bleeding such as melena, hematochezia, or visible blood loss. The following case report presents a 77-year-old female who presented with altered mental status. The patient, subsequently had a hgb of 7 and findings of frank GI hemorrhage due ultimately to Cameron lesions. The patient is a 77 year old female with a past medical history of dementia, depression, insomnia, Alzheimer's, Parkinson's osteoarthritis and hypertension was brought by Emergency Medical Services from an assisted living facility to Larkin Hospital Palm Spring Campus for confusion and AMS. The ALF nursing staff states the patient had a copious amount of melena. Chest x-ray was significant for large hiatal hernia. Complete blood count revealed a hemoglobin level of 7 and a mean corpuscular volume of 70. Iron studies were ordered which revealed iron deficiency. An EGD was performed that demonstrated multiple large circumferential Cameron ulcers that were non-bleeding and a large 5 cm hiatal hernia. The source of the bleed was determined to be the ulcers and medical management was initiated. The patient began treatment with a proton pump inhibitor and continued iron supplementation. The patient was then discharged once her hemoglobin proved stable. This case demonstrates a rare cause of frank GI hemorrhage. The incidence of Cameron lesions is liable to increase. Hiatal hernias are associated with an increased body mass index (BMI) (8). As our society moves to an ever-increasing national average for BMI, bleeding secondary to Cameron lesions should be placed on the differential and an EGD should be carefully performed. More research needs to be performed on surveillance for these patient's once a cameron ulcer and lesion has been found to be a cause of overt GI bleeding.