Massive Upper Gastrointestinal Bleeding from Extensive Fundic Ulcerations Covered by a Large Adherent Clot: A Rare Case of Ischemic Fundic Injury After Hemorrhagic Shock

Background: Fundic ulcerations are rare because of the rich vascularization of the gastric fundus. When they occur, they often signal unusual underlying mechanisms such as ischemia, vascular lesions, or neoplastic infiltration [1,2]. Case Presentation: We describe a 46-year-old woman with no prior gastrointestinal history who developed extensive fundic ulcerations covered by a large adherent clot following hemorrhagic shock secondary to uterine artery rupture. Five days after resuscitation, she presented with melena and hypotension. Endoscopy revealed a 4-cm adherent black clot in the gastric fundus, covering an 8 × 5 cm ulcer extending toward the lesser curvature. No active bleeding was noted (Forrest IIb). Histology showed ischemic necrosis without H. pylori or malignancy. The patient was managed conservatively with intravenous proton pump inhibitors (PPI), parenteral nutrition, and hemodynamic support. Follow-up endoscopy at day 10 showed partial healing, and complete epithelialization was confirmed at six weeks. Conclusion: Ischemic fundic ulceration is a rare but important cause of upper GI bleeding after systemic hypoperfusion. Awareness of this condition allows conservative management and avoids unnecessary surgical intervention [3,4].