S6434 A Hidden Culprit: Gastric Diverticulum Presenting With Life-Threatening Upper GI Bleeding

Introduction: Gastric diverticula (GD) are the rarest form of gastrointestinal tract diverticulum with an estimated incidence of 0.013%–2.6% and extremely low rate of bleeding. While most are asymptomatic and discovered incidentally, complications such as life-threatening bleeding, perforation can occur, though they are exceedingly rare. Upper gastrointestinal (GI) bleeding from a gastric diverticulum is a seldom-reported phenomenon, with only a handful of documented cases in the literature. We present a case of a 71-year-old woman with hematemesis secondary to bleeding from a gastric fundus diverticulum, successfully managed with endoscopic therapy. This case highlights the importance of considering gastric diverticula in the differential diagnosis of obscure upper GI bleeding, particularly when more common etiologies (e.g., peptic ulcers, varices, Mallory-Weiss tears) have been excluded. Case Description/Methods: Seventy-one-year-old White woman with multiple comorbidities including gastroesophageal reflux disease, dysphagia, irritable bowel syndrome presented with acute nausea, vomiting, and hematemesis. Initial hemoglobin was 10.9 g/dL which dropped to 8.5 g/dL. Computed tomography (CT) abdomen/pelvis with contrast was unremarkable except for a stable splenic artery aneurysm. Esophagogastroduodenoscopy (EGD) revealed a 2 cm actively bleeding diverticulum in the proximal gastric fundus, which was treated with epinephrine injection, 8 hemoclips, and Hemospray. Large fresh blood/clots were evacuated via Roth net. No further hematemesis or bleeding was observed post-intervention. The diverticular bleed was identified as the definitive source of her upper GI hemorrhage. Discussion: Gastric diverticula are rare, typically asymptomatic, but may cause epigastric pain (18–30%), nausea, or refractory gastroesophageal reflux disease-like symptoms. Life-threatening complications (bleeding, perforation, diverticulitis, malignancy) are exceedingly rare. Food retention and digestive juices may trigger inflammation, ulceration, or hemorrhage. GD should be considered in obscure upper GI bleeding after excluding common causes. Endoscopy is diagnostic and therapeutic, while CT may detect incidental cases. Surgery (laparoscopic/open) is reserved for recurrent bleeding or perforation. This case highlights GD as a rare but critical bleeding source, emphasizing early endoscopy for diagnosis and management.