• Muhammad Waseem, Rich Teitell, Matthew Vasey, Elaine Josephson, and Yocheved Rose.
• Department of Emergency Medicine, Lincoln Medical Center, Bronx, New York 10451, USA.
• J Emerg Med. 2013 Jan 1;44(1):e25-8.

BackgroundAcute upper gastrointestinal (GI) bleed is a well-known presentation to the emergency department (ED) frequently accompanied by hematemesis. We describe the case of a patient with abdominal content herniation into the chest wall with a recent history of coronary artery bypass graft presenting with acute onset of hematemesis.ObjectivesTo present an exceedingly rare herniation of abdominal contents into the chest wall that was accompanied by hematemesis and to present the rare visual findings inherent in this pathology.Case ReportA 65-year-old man presented to the ED vomiting large amounts of blood upon presentation, compromising hemodynamic stability and prompting emergent resuscitation. The patient's presentation was complicated by a large 30 × 40-cm anterior chest wall mass extending 2 cm inferior to the sternal notch expanding with each episode of hematemesis. Computed tomography after stabilization revealed a large ventral hernia extending into the chest wall, containing small and large bowel. We suspected this large, unusual hernia to be the underlying cause of the patient's GI bleeding.ConclusionThe emergency physician must be able to assess hemodynamic stability of an upper GI bleed and resuscitate the unstable patient if warranted. Diagnosis is to be subsequently determined after stabilization.Copyright © 2013 Elsevier Inc. All rights reserved.

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