Case Report: Massive Upper Gastrointestinal Hemorrhage Due to Spontaneous Gastric Intramural Hematoma

<ns3:p>Spontaneous gastric intramural hematoma (GIH) is an exceptionally rare cause of upper gastrointestinal bleeding. We report the case of a 57-year-old man with no significant medical history who presented with hematemesis, melena, and hemodynamic instability. Upper endoscopy revealed a large submucosal hematoma with active bleeding. Despite endoscopic hemostasis and supportive management, hemorrhage persisted, requiring emergency partial gastrectomy. Histopathological examination confirmed submucosal hemorrhage without evidence of malignancy or vascular malformation. The patient had an uneventful postoperative recovery. This case underscores the importance of considering spontaneous GIH in the differential diagnosis of unexplained upper gastrointestinal bleeding and highlights the role of timely surgical intervention when endoscopic therapy fails.</ns3:p>