Unexpected source of massive GI bleed: metastatic renal cell carcinoma and widespread thrombosis – a case report

Introduction: Upper gastrointestinal bleeding (UGIB) is a potentially life-threatening condition that most commonly arises from peptic ulcers, esophageal varices due to portal hypertension, or mucosal erosions. Variceal bleeding in the absence of liver disease is uncommon and warrants thorough investigation. Case Presentation: This case report presents a 56-year-old male who experienced his first episode of hematemesis and melena. Endoscopic evaluation revealed a high-risk bleeding fundal varix, despite no clinical or laboratory evidence of chronic liver disease. Abdominal ultrasound revealed a large left renal mass consistent with renal cell carcinoma, with extensive vascular thromboses involving the portal vein, inferior vena cava, and splenic vein, leading to localized portal hypertension and variceal formation. Despite planned diagnostic and therapeutic interventions, the patient suffered a fatal pulmonary embolism. This case underscores the importance of considering malignancy-related vascular complications in non-cirrhotic variceal bleeding. Conclusion: The presentation of UGIB due to isolated gastric varices in a non-cirrhotic patient should prompt evaluation for underlying malignancies, including renal cell carcinoma (RCC). The aggressive vascular invasion characteristic of RCC can lead to significant complications, including portal hypertension and thromboembolic events. Early diagnosis and management are essential to improve patient outcomes.