Obscure Gastrointestinal Bleeding from an Ampullary Tumour in a Patient with a Remote History of Renal Cell Carcinoma: A Diagnostic Conundrum

Abstract

Metastasis of renal cell carcinoma to the ampulla of Vater is a rare occurrence. The outlined case, which presented as an upper gastrointestinal bleed, is only the eighth such reported case in the English-language literature. This case is the longest reported time interval between surgical nephrectomy to presentation with ampullary metastasis at 17.5 years. The ampullary source of bleeding in this case was initially obscure and missed by conventional gastroscopy. Diagnosis was made with a side-viewing endoscope, emphasizing the usefulness of this instrument in the investigation of active bleeding from a small bowel source.

Renal cell carcinoma presenting as an upper gastrointestinal bleeding

“…[4][5][6][7] The vast majority of relevant case reports describe the more recognised metastatic route. [8][9][10][11][12][13][14] This report and the supporting literature search demonstrate that by investigating those patients presenting with GI bleed, we may in fact find an index presentation for an advanced malignancy such as RCC, as in this case. We acknowledge this is rare and present this case as an interesting differential for upper GI haemorrhage.…”

Metastases from renal cell carcinoma presenting as gastrointestinal bleeding: two case reports and a review of the literature

“…The source of bleeding in this case was obscure and initially missed by conventional gastroscopy – earlier diagnosis may have been facilitated using a side-viewing endoscope as described previously in a case of RCC metastasizing to the duodenal ampulla [27]. Bleeding in our patient was managed radiologically and without complication, by selective trans-catheter embolisation of the anterior and posterior pancreaticoduodenal arteries.…”

Metastatic renal cell carcinoma diagnosed by capsule endoscopy and double balloon endoscopy

“…Furthermore, RCC very rarely metastasizes to the small intestine. Commonly, renal cell metastases present many years after initial treatment, with recurrences reported up to 17.5 years after initial surgery [4]. Our case had small intestinal metastasis 6 years after his initial surgery.…”