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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3182504a09
Image of the Month

Cameron Ulcer

Djurić, Zlatko*; Nagorni, Aleksandar

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*Division of Gastroenterology, Children's Hospital

Clinic of Gastroenterology and Hepatology, University of Niš School of Medicine, Niš, Serbia.

Address correspondence and reprint requests to Zlatko Djurić, PhD, Assistant Professor of Pediatrics and Head, Division of Gastroenterology, Children's Hospital, University of Niš School of Medicine, Dr Zoran Djindjić Blvd. 48, Niš 18000, Serbia (e-mail: zldjuric@yahoo.com).

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

The authors report no conflicts of interest.

A 12-year-old boy with severe anemia presented with a 2-month history of vomiting. His medical history was noncontributory except for developmental delay of unclear etiology. He was not taking any medications and was found to be malnourished (body mass index 11.5 kg/m2). The laboratory workup was normal except for severe iron-deficiency anemia with a hemoglobin of 7.3 g/dL, serum ferritin 51.7 μg/L, iron 4.26 μmol/L, and total iron-binding capacity 67.5 μmol/L. Esophagogastroduodenoscopy showed a large sliding hiatal hernia and elipsoidal ulcer in the hernia (Figs. 1 and 2). Histopathological examinations of the distal esophagus, the stomach, and the duodenum were normal. He responded well to omeprazole therapy and iron supplementation. Repeat esophagogastroduodenoscopy demonstrated large hiatal hernia, but without ulcer.

Figure 1
Figure 1
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Figure 2
Figure 2
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Cameron lesions were first described 25 years ago by Cameron and Higgins (1) as linear erosions or ulcers in hiatal hernia. Since then, there have been a limited number of reports in adults, whereas the occurrence in children has been rarely described, with only 1 report without endoscopic pictures (2). Apart from linear forms, Cameron ulcer may have some other forms (eg, round, elipsoidal) (3). Despite many hypotheses, the etiology of Cameron lesions remains unknown (4). The significance of these lesions is reflected in significant bleeding complications (5). There are also rare descriptions of hiatal hernia ulcer perforation into the peritoneal cavity, as well as penetration into the diaphragm, pericardium, myocardium, great blood vessels, and pleural cavity (6). The initial therapy of Cameron lesions is based on antisecretory drugs and iron supplementation. The hiatal hernia surgical therapy with fundoplication is applied in patients who have lesions refractory to medical treatment, as well as in patients with the complications mentioned above (7).

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REFERENCES

1. Cameron AJ, Higgins JA. Linear gastric erosion. A lesion associated with large diaphragmatic hernia and chronic blood loss anemia. Gastroenterology 1986; 91:338–342.

2. Zaki SA, Dadge D, Shanbag P. Diaphragmatic hernia presenting as gastrointestinal bleeding. Indian Pediatr 2010; 47:185–187.

3. Chun CL, Conti CA, Triadafilopoulos G. Cameron ulcers: you will find only what you seek. Dig Dis Sci 2011; 56:3450–3452.

4. Maganty K, Smith RL. Cameron lesions: unusual cause of gastrointestinal bleeding and anemia. Digestion 2008; 77:214–217.

5. Lin CC, Chen TH, Ho WC, et al. Endoscopic treatment of a Cameron lesion presenting as life-threatening gastrointestinal hemorrhage. J Clin Gastroenterol 2001; 33:423–424.

6. Boyd EJ, Penston JG, Russell RI, et al. Hiatal hernia ulcers: clinical features and follow-up. Postgrad Med J 1991; 67:900–903.

7. Moschos J, Pilpilidis I, Kadis S, et al. Cameron lesion and its laparoscopic management. Indian J Gastroenterol 2005; 24:163.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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