[Unusual Ulcer Bleeding in the Stomach]

Emergency upper gastrointestinal endoscopy in a 45 years old man with a complicated medical history obtained a small ulcer in the gastric corpus bedded in a round impression of 4 cm in diameter and no active bleeding during investigation. We decided to perform an immediate angio-CT-examination of thorax and abdomen. Gastric ulcer and impression were induced by a partially thrombosed aneurysm of the splenic artery. Emergency angiography with percutaneous transluminal implantation of a covered stent into the splenic artery completely bridged the aneurysm. The patient resolved and left the hospital after 12 days. Literature review shows that currently an immediate switch from endoscopy to vascular surgery is the best option in such cases. Emergency endoscopists have to identify the so called herald lesion as what it is and to initiate further diagnostic steps at once, since the second bleeding is mostly fatal. This may increase the prognosis significantly to 20-90 % survival. Unfortunately, in a current survey 50 % of gastroenterologists felt themselves not good informed about this fact and would probably not have done the correct decisions.