Hematemesis Caused by Forgotten Corrective Device
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In Chul An
A 77-year-old woman presented to the emergency department with acute abdominal pain, coffee-ground emesis, and melena. Her medical history included type 2 diabetes mellitus, a hiatal hernia that was repaired more than 20 years prior, and pulmonary embolism. Her current medication included anticoagulation therapy to prevent pulmonary embolisms. Her vital signs were normal, but she appeared pale. A complete blood cell count showed a hemoglobin level of 7.8 g/dL. Esophagogastroduodenoscopy revealed old blood clots in the patient's stomach and foreign material in the gastric fundus with an ischemic ulcer (image A). A computed tomographic scan of her abdomen revealed an abnormally positioned Angelchik prosthesis, from her previous hiatal hernia repair, eroding into her gastric fundus without pneumoperitoneum (image B, arrow). Anticoagulation therapy was discontinued, and an inferior vena cava filter was placed. The patient remained stable and was discharged 4 days after admission with recommendation for outpatient evaluation and prosthesis removal.
The Angelchik prosthesis is a C-shaped silicon ring developed in 1979 to fit across the gastroesophageal junction to manage gastroesophageal reflux disease and hiatal hernia.1 Its use has been discontinued because of high rates of dysphagia, prosthesis migration and erosion, and development of esophageal adenocarcinoma from persistent acid reflux.2,3
References
1. Angelchik JP , CohenR. A new surgical procedure for the treatment of gastroesophageal reflux and hiatal hernia. Surg Gynecol Obstet. 1979;148(2):246-248.Search in Google Scholar
2. Shetty VD , ThrumurthySG, PursnaniKG, WardJB, MughalMM. Angelchik prosthesis with oesophageal adenocarcinoma: our surgical approach. Ann R Coll Surg Engl. 2010;92(5):W64-W68. doi:10.1308/147870810X12699662980835Search in Google Scholar PubMed PubMed Central
3. Mercer SJ , TohSK, SomersSS. Esophageal adenocarcinoma developing above an Angelchik prosthesis. Dis Esophagus. 2007;20(6):546-548.10.1111/j.1442-2050.2007.00698.xSearch in Google Scholar PubMed
© 2017 American Osteopathic Association
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Articles in the same Issue
- HEALTH POLICY
- Financing Reform for Long-term Services and Supports
- LETTERS TO THE EDITOR
- Reclassification of the Sacral Autonomic Outflow to Pelvic Organs as the Caudal Outpost of the Sympathetic System Is Misleading
- CORRECTION
- Correction
- AOA COMMUNICATION
- Official Call: 2017 Annual Business Meeting of the American Osteopathic Association (Reprint)
- Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics (Reprint)
- ORIGINAL CONTRIBUTION
- Cardiovascular Disease Risk Factors After an Employer-Based Risk Reduction Program: An Observational Cohort Study
- Effect of Latitude on Vitamin D Levels
- REVIEW
- Reducing Off-Label Antipsychotic Use in Older Community-Dwelling Adults With Dementia: A Narrative Review
- MEDICAL EDUCATION
- Integrating Point-of-Care Ultrasonography Into the Osteopathic Medical School Curriculum
- SPECIAL COMMUNICATION
- Highlights From the American Diabetes Association's 2017 Standards of Medical Care in Diabetes for Osteopathic Physicians
- CASE REPORT
- Thrombocytopenia and Spontaneous Intracranial Hemorrhage After Olanzapine Therapy
- THE SOMATIC CONNECTION
- Heads Up on Headers: Effects of Soccer Ball Heading on Brain Function
- Effects of Manual Therapy on Patients With Carpal Tunnel Syndrome
- Manual Therapy to Manage Carpal Tunnel Syndrome
- Osteopathic Manipulative Therapy for Foot-Pain: How Many Sessions? How Often?
- CLINICAL IMAGES
- Hematemesis Caused by Forgotten Corrective Device
