title: Metastases from renal cell carcinoma presenting as gastrointestinal bleeding: two case reports and a review of the literature.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology, City Hospital, Dudley Road, Birmingham B18 7QH, UK. garethsadler@hotmail.com
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Sadler
authors.forename: Mark R
authors.initials: MR
authors.lastname: Anderson
authors.forename: Mark S
authors.initials: MS
authors.lastname: Moss
authors.forename: Paul G
authors.initials: PG
authors.lastname: Wilson
mesh_terms: D000368:Aged; D000740:Anemia / Q000209:etiology; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000175:diagnosis / Q000556:secondary*; D004379:Duodenal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000556:secondary*; D017809:Fatal Outcome; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis*; D008297:Male; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000556:secondary*