Rare Complication of Peptic Ulcer Disease in a Hemopheliac

Abstract

A49 year-old Caucasian man presented to the Emergency Department for hematemesis and syncope. He had a history of hemophilia A. He was lethargic, hypotensive, and tachycardic upon presentation. He was adequately stabilized with fluids, blood products, and recombinant factor VIII. Computed tomography with contrast of the abdomen and pelvis showed an 8 cm × 6 cm × 9 cm hematoma vs abscess interposed between the left hepatic lobe of a cirrhotic liver and the gastric antrum (Figure A, white arrows). An esophagogastroduodenoscopy showed a 3.5-cm fibrous clot eroding through the gastric mucosa (Figure B), with extrinsic compression along the wall of the anterior portion of the gastric antrum (Figure C).