Cameron Ulcer

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: Endoscopic appearance of Cameron ulcer in retrograde view.FIGURE 2: Endoscopic appearance of Cameron ulcer in antegrade view.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).