Mission: Educational

Background: Bleeding from small bowel neoplasms account for 1–4% of cases of upper gastrointestinal haemorrhage. Renal cell carcinoma constitutes 3% of all adult malignancies and often presents insidiously. Consequently 25–30% of patients have metastases at the time of diagnosis. Gastrointestinal bleeding from renal cell carcinoma metastases is an uncommon and under-recognised manifestation of this disease. Case Report: In this report we describe two cases of gastrointestinal bleeding from renal cell carcinoma metastases – in one patient bleeding heralded the primary manifestation of disease and in the other signified recurrence of disease following nephrectomy. Conclusion: These cases highlight the importance endoscopic vigilance in cases of undiagnosed upper gastrointestinal haemorrhage, especially in patients with a past history of renal cell carcinoma. Background It is estimated that in 7–25% of patients who undergo endoscopy for suspected upper gastrointestinal haemorrhage, no source of bleeding is identified [1]. Malignant causes of upper gastrointestinal bleeding account for 1– 4% of cases. Tumours of the small intestine are uncommon, comprising 0.35% of all malignancies [1], and symptoms are frequently non-specific. Consequently diagnosis is often difficult and may be delayed. Indeed, less than 50% of small bowel lesions are considered surgically resectable at diagnosis [2]. Thorough endoscopic evaluation of the upper small intestine and a high index of suspicion are vital for correct diagnosis and appropriate management of these lesions. Renal cell carcinoma (RCC) behaves unpredictably and has a diverse range of clinical manifestations. Patients often present insidiously with vague abdominal symptoms – the classic triad of haematuria, loin pain and abdominal mass is found in only 4–17% [3,4]. Accordingly, 25–30% of patients are found to have metastases at diagnosis. A further 30–50% of patients with local disease will develop metastases during the course of their illness [5]. Metastases to the pancreas and small intestine in RCC are rare, but can present as gastrointestinal bleeding [6,7]. We describe two cases of pancreatico-duodenal metastasis in RCC presenting with upper gastrointestinal haemorrhage Published: 31 January 2007 BMC Gastroenterology 2007, 7:4 doi:10.1186/1471-230X-7-4 Received: 23 August 2006 Accepted: 31 January 2007 This article is available from: http://www.biomedcentral.com/1471-230X/7/4 © 2007 Sadler et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.