Systemic Signs of an Unexpected Guest in a Case of Apparent Upper Gastrointestinal Bleeding Leading to an Endoscopic Extraction of a Foreign Body: A Case Report

TL;DR

A man with symptoms of upper GI bleeding was found to have anaphylaxis from accidentally ingesting wasps, highlighting the need for broad differential diagnoses in emergencies.

Contribution

This case report presents a rare instance of anaphylaxis mistaken for GI bleeding due to wasp ingestion, emphasizing diagnostic vigilance.

Findings

Endoscopy revealed two dead wasps in the gastric antrum, not active bleeding.

The patient's symptoms were attributed to anaphylaxis from wasp venom, not hemorrhagic shock.

Treatment with antihistamines led to improvement, confirming the non-hemorrhagic etiology.

Abstract

Background and Clinical Significance: Upper gastrointestinal (GI) bleeding is a common emergency, typically requiring prompt intervention. This case report presents a unique situation where apparent GI bleeding was ultimately identified as anaphylaxis triggered by accidental wasp ingestion. Such cases are rare, underscoring the need for a broad differential diagnosis in atypical presentations. Case Presentation: A 53-year-old male with a history of heavy alcohol use presented with presumed acute hematemesis, hypotension, and tachycardia. An initial examination revealed mild anemia and elevated liver enzymes. An urgent upper GI endoscopy showed severe esophagitis with no signs of active or stigmata of recent bleeding; instead, two dead wasps were found in the gastric antrum. Further inquiry revealed that the patient had recently consumed a home-brewed alcoholic beverage, likely contaminated with the wasps. The patient’s symptoms were then attributed to anaphylaxis from venom exposure rather than hemorrhagic shock. The patient’s condition improved with antihistaminic therapy, and he was discharged with follow-up recommendations. Conclusions: This case highlights the importance of considering rare but critical diagnoses, such as insect-induced anaphylaxis, in patients presenting with presumed GI bleeding. It reinforces the value of thorough history taking, prompt endoscopy, and systematic management in assessing and treating atypical emergency presentations.

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