Diagnosis and management of massive gastrointestinal bleeding owing to duodenal metastasis from renal cell carcinoma

We report 3 cases in which duodenal metastases from renal cell carcinoma caused massive upper gastrointestinal bleeding. In 2 patients the initial symptom was melena and 1 experienced hematobilia. In 2 patients the diagnosis was not suspected until a hypervascular mass was seen on arteriography and the bleeding was controlled by embolization of the gastroduodenal artery. In the third patient an aorto-enteric fistula was suspected on contrast-enhanced computerized tomography but arteriography showed hypervascular metastases in the duodenum.