Metastases from renal cell carcinoma presenting as gastrointestinal bleeding: two case reports and a review of the literature

Bleeding from small bowel neoplasms account for 1-4% of cases of upper gastrointestinal haemorrhage. Renal cell carcinoma constitutes 3% of all adult malignancies and often presents insidiously. Consequently 25-30% of patients have metastases at the time of diagnosis. Gastrointestinal bleeding from renal cell carcinoma metastases is an uncommon and under-recognised manifestation of this disease.In this report we describe two cases of gastrointestinal bleeding from renal cell carcinoma metastases - in one patient bleeding heralded the primary manifestation of disease and in the other signified recurrence of disease following nephrectomy.These cases highlight the importance endoscopic vigilance in cases of undiagnosed upper gastrointestinal haemorrhage, especially in patients with a past history of renal cell carcinoma.