Bleeding Gastric Ulcer

Left: 77 year-old man presented with acute hematemesis (vomiting blood). Exam revealed this ulcer (at 9:00 o'clock position) with a white, fibrinous base, and a dark, protruding visible vessel, signifying the site of recent bleeding.

Center: 72 year-old woman with hematemesis. Endoscopy demonstrated a small ulcer with bleeding from the edges, but no visible vessel. Biopsies were positive for Helicobacter pylori.

Right: 71 year-old man with hematemesis. Endoscopy revealed a 2 cm ulcer with pulsatile, arterial bleeding. Control of bleeding was achieved by injecting the vessel with epinephrine, followed by bipolar electrocautery.

72 year-old man who presented with acute hematemesis. Endoscopy revealed a small bleeding ulcer (left and center); bleeding was massive despite the small size of the ulcer. Bleeding was controlled by banding (right). The blue rubber band and the mucosal bleb created by banding are visible through the translucent endoscope attachment used in the banding process.