Abstract

This 56 years old gentleman had history of severe bleeding through mouth, admitted in a hospital and underwent emergency endoscopy and failed to evaluate and biopsy of lesion as huge bleeding and obscuring field of vision. Resuscitation done and stabilized. For further evaluation shifted to tertiary care centre (IGMH&DH). Re endoscopy scheduled and a lesion found in fundic area posterior wall of stomach. Lesion was bled on touch and with highly vascularity, cant proceeding for biopsy and planned for elective laparoscopic sleeve gastrectomy. Before elective surgery 2 days after re endoscopy, at morning patient starts with profuse hematemesis and hemodynamic instability. Emergency exploration was done by upper midline incision. Stomach found hugely distended and loaded with blood. NG tube was difficult to introduce in stomach for its blood content. Incision extended up to left subcostal and planned for gastrotomy to resect the lesion and evacuate blood. More than 1.5 l of clotted blood removed. Lesion identified and it was pedunculated (approx. 8 cm × 4 cm), highly vascular with umbilication. Submucosal resection done with closure of base. Anterior wall of stomach repaired and drain tube kept in left paracolic gutter. Patient shifted to Critical care unit for initial supportive management and improved gradually.