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October 28, 1974

Intramural Gastric Lesion With Sudden Abdominal Pain

Author Affiliations

From the Department of Radiology, St. Joseph's Hospital, Lewiston, Idaho.

JAMA. 1974;230(4):603-604. doi:10.1001/jama.1974.03240040071046

History  A 22-year-old man was admitted to the hospital with a history of sudden onset of severe, unrelenting epigastric pain associated with nausea and vomiting of eight hours' duration. Hematemesis, melena, and changes in bowel habits were all denied. He had had no previous abdominal complaints and gave no history of trauma. Physical examination disclosed diffuse upper abdominal tenderness with a questionable epigastric mass. One piece of information is being withheld.An upper gastrointestinal series was performed (Fig 1).

Diagnosis  Intramural gastric hematoma in a hemophiliac.

Comment  The roentgenogram (Fig 1) shows a 12X6-cm mass projecting into the lumen of the stomach from the greater curvature. The surface of the mass appears slightly irregular, and its junction with the greater curvature is not sharp but slightly undercut.The clinical information withheld was that the patient was a known hemophiliac who had had previous hemarthroses and one episode of retroperitoneal bleeding.