IS case 544: Cameron ulcer

Wade Hedegard, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-09-17

History

Patient is a 68-year-old female presenting with upper GI bleeding and black tarry stools.

Findings

Overhead and spot fluoroscopic images from an upper GI examination demonstrated a large hiatal hernia with linear ulceration along the lesser curvature of the stomach at the level of the diaphragm. There was surrounding fold thickening adjacent to the ulceration.

Diagnosis

Cameron ulcer

Discussion

Cameron lesions are linear gastric ulcers or erosions of the lesser curvature at the diaphragmatic impression in patients with a large hiatal hernia. The pathophysiology of these lesions may be due to mechanical trauma from diaphragmatic contraction or secondary to acid secretion or infection with H. pylori. Cameron ulcers may present with gastrointestinal bleeding or anemia. The diagnosis is most commonly made at upper endoscopy. Approximately 5% of patients with hiatal hernias will have a Cameron lesion. The larger the hernia, the more likely an ulcer will form. Up to 20% of patients with hiatal hernias greater than 5cm will have ulceration. Treatment of Cameron ulcers is primarily medical therapy including acid suppression and iron supplementation, although surgical correction is occasionally required.

References

1. Maganty K, Smith RL. Cameron lesions: unusual cause of gastrointestinal bleeding and anemia. Digestion 2008;77:214–217. Digestion. 2008;77(3-4):214-7. PMID: 18622137