Recommended Citation
Siddiqui A, Khorasani A. Cameron lesion in the setting of a diaphragmatic hernia leading to occult bleeding. Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Presentation Notes
Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Abstract
Introduction: Diaphragmatic hernias can present as symptoms that are similar in nature to acid reflux disease or even gastroparesis. Cameron lesions, which are uncommon ulcerations at the hiatus of a hernia, present themselves as occult bleeding. Case Presentation: A 65 y/o male with PMH of ESRD on HD, diaphragmatic hernia, HTN, and DM presented for an LUE AVF creation with plans for a supraclavicular block with sedation. During preoperative evaluation, the patient endorsed he was asymptomatic from his hernia diagnosis which was made several years ago. The case was uneventful until heparin administration, after which the patient had significant emesis requiring conversion to GA and removal of contents from the airway and gastrum. EGD was performed post operatively revealing an erosion at the hiatus of the hernia, identified as a Cameron lesion that was the likely source of his bleeding and emesis after heparin. These lesions are typically seen as a mucosal erosion or ulcer in the presence of a medium to large hiatal hernia. Unfortunately, they are not routinely diagnosed until after an occult bleeding event or chronic anemia. Conclusion: Preoperative evaluation is key in perioperative care to ensure patient safety. While some conditions present themself unexpectedly, proper post operative care and evaluation of patients moving forward should be taken into consideration. Patients with moderate to large hiatal hernias, particularly those with symptoms, should undergo GI evaluation and possibly endoscopic intervention before elective procedures. Cameron lesions, while they can be medically management if diagnosed, often require more invasive treatments to prevent episodes of occult or chronic bleeding. 1. Gray DM, et al. (2015) Dis Esophagus.28(5):448-52
Type
Oral/Podium Presentation
Affiliations
Advocate Illinois Masonic Medical Center