A VERY RARE CAUSE OF DIGESTIVE HEMORRHAGE

Aims Case report

Methods –

Results This is a case study of an 82-year-old woman with a history of hypocoagulated atrial fibrillation, microcytic anemia and excised left genial malignant lentigo in 2018. She was admitted to the emergency department due to asthenia and decreased strength of the inferior limbs with two days of evolution. No visible blood loss was evident. She presented a history of darkened feces although she was under oral iron therapy. In the objective examination she had pale mucous membranes and a systolic murmur. Abdominal and neurologic examination were normal. Blood analysis: hemoglobin 6.5g/dL, INR 13.08 and urea 132mg/dL. She underwent erythrocyte concentrate transfusion and reverted the iatrogenic hypocoagulation. Abdominal ultrasound revealed thickening of the gastric antrum and multiple adenopathies nearby the head of the pancreas. Upper digestive endoscopy revealed several circular and friable, black papular lesions in the body and fundus gastric and duodenal bulb, with depressed center and with stigmas of recent hemorrhage.

Biopsies of the lesions were performed, whose histology revealed malignant melanoma metastases. From the complementary study, CT-TAP showed multiple pulmonary, mediastinal and peritoneal nodular formations, suggestive of secondary lesions. After a multidisciplinary assessment, it was decided the admission to the Palliative Care Unit.

Conclusions Malignant melanoma has a predisposition to metastasise to the GI tract. This case illustrates an unusual form of manifestation of this neoplasm which was identified in the sequence of iatrogenic coagulation alteration. The case highlights the rarity of the collected iconography.

Publication History

Article published online:
14 April 2022