Large Hiatal Hernia Associated with Cameron Ulcers and Consecutive Sideropenic Anemia: Case Presentation


  • Zaim Gashi Clinic of Gastroenterology with Hepatology, UBT College, UCCK, Prishtina, Kosovo
  • Arjeta Gashi Institute of Pharmacology, UCCK, Prishtina, Kosovo
  • Fadil Sherifi Department of Internal Medicine, Clinic of Gastroenterology with Hepatology, UCCK, Prishtina, Kosovo
  • Fitore Komoni Department of Internal Medicine, Clinic of Gastroenterology with Hepatology, UCCK, Prishtina, Kosovo



Large hiatal hernia, Endoscopy, Cameron ulcer, Fundoplication


BACKGROUND: Cameron lesions are seen in 5.2% of patients with hiatal hernia who undergo esophagogastroduodenoscopic examinations. The prevalence of Cameron lesions seems to be dependent on the size of the hernial sac, with an increased prevalence in the larger-sized sac. In about two-thirds of the cases, multiple Cameron lesions are noted rather than a solitary erosion or ulcer.

AIM: The aim of this case report is to present the patient with Cameron ulcers associated with hiatal hernia.

CASE PRESENTATION: Our patient presented with postprandial retrosternal pain, especially immediately after eating, vomiting, dyspnea, weight loss, fatigue, signs, and symptoms of severe hypochromic microcytic anemia without signs of acute gastrointestinal bleeding. No history of gastroesophageal disease. Colonoscopy was done and eliminate colic cause of anemia. The endoscopy showed a large hiatal hernia and linear erosions and ulcerations at the level of gastrodiaphragmatic contact (Cameron ulcers) and one non-sanguinant subcardial elipsoid ulceration. After conservative and operative treatment, there was significant clinically and laboratory improvement definitively, after 6 months. Cameron lesion is a rare cause of refractory sideropenic anemia. Diagnosis is very difficult in developing countries, where iron deficiency anemia is more common. A history of disease, clinical course, and laboratory findings are the important facts for diagnosis.

CONCLUSION: Endoscopy is the gold standard for diagnosis, although it is not uncommon to overlook these lesions due to their unique location. There are two modalities for the treatment of Cameron lesions: Medical or surgical, which should be individualized for each patient. By severe refractory anemia and large hiatal hernia, associated with clinical signs, surgical approach is very important.


Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


Weston AP. Hiatal hernia with Cameron ulcers and erosions. Gastrointest Endosc Clin N Am 1996;6(4):671-9. Mid:8899401

Cameron AJ, Higgins JA. Linear gastric erosion. A lesion associated with large diaphragmatic hernia and chronic blood loss anemia. Gastroenterology. 1986;91(2):338-42. PMid:3487479

Maganty K, Smith RL. Cameron lesions: Unusual cause of gastrointestinal bleeding and anemia. Digestion. 2008;77(3- 4):214-7. PMid:18622137

Moskovitz M, Fadden R, Min T, Jansma D, Gavaler J. Large hiatal hernias, anemia, and linear gastric erosion: Studies of etiology and medical therapy. Am J Gastroenterol. 1992;87(5):622-6. PMid:1595651

Nguyen N, Tam W, Kimber R, Roberts –Thomson IC, Gastrointestinal: Camron’s erosions. J Gastroenterol Hepatol. 2000. PMid:11982707

Zaman A, Katon RM. Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of a standard endoscope. Gastrointest Endosc. 1998;47(5):372-6. PMid:9609429

Gray DM, Kushnir V, Kalra G, Rosenstock A, Alsakka MA, Patel A, et al. Cameron lesions in patients with hiatal hernias: Prevalence, presentation, and treatment outcome. Dis Esophagus. 2015;28(5):448-52. PMid:24758713

Camus M, Jensen DM, Ohning GV, Kovacs TO, Ghassemi KA, Jutabha R, et al. Severe upper gastrointestinal hemorrhage from linear gastric ulcers in large hiatal hernias: A large prospective case series of Cameron ulcers. Endoscopy. 2013;45(5):397-400. PMid:23616128

Sehested TSG, Carlson N, Hansen PW, Gerds TA, Charlot MG, Torp-Pedersen C, et al. Reduced risk of gastrointestinal bleeding associated with proton pump inhibitor in patients treated with dual antiplatelet therapy after myocardial infarction. Eur Heart J. 2019;40(24):193-1970. PMid:30851041

Tjwa ET, Holster IL, Kuipers EJ. Endoscopic management of nonvariceal, nonulcer upper gastrointestinal bleeding. Gastroenterol Clin North Am 2014;43:707-19. PMid:25440920

Lin CC, Chen TH, Ho WC, Chen TY. Endoscopic treatment of a Cameron lesion presenting as life-threatening gastrointestinal hemorrhage. J Clin Gastroenterol. 2001;33(5):423-4. PMid:11606864




How to Cite

Gashi Z, Gashi A, Sherifi F, Komoni F. Large Hiatal Hernia Associated with Cameron Ulcers and Consecutive Sideropenic Anemia: Case Presentation. Open Access Maced J Med Sci [Internet]. 2021 Sep. 26 [cited 2021 Nov. 30];9(C):167-9. Available from:



Case Report in Surgery