Abstract
Not only as a referred pain due to acute myocardial infarction, but also shoulder pain has been reported as a rare symptom of perforated peptic ulcer. However, shoulder pain due to non- perforated gastric ulcer has not been reported previously. We describe the case of an 86-year-old anticoagulant user with non-perforated hemorrhagic gastric ulcer manifesting with left shoulder pain and orthostatic dizziness. The shoulder pain responded to proton pump inhibitor administration without specific shoulder pain treatment. Although such shoulder pain is a referred pain due to perforated peptic ulcer in association with phrenic irritation, it has not been reported as a symptom for patients with non-perforated peptic ulcer. Orthostatic dizziness is an important sign of gastrointestinal bleeding by elderly patients, as tachycardia and abdominal pain are less incident for them. Our experience with this case suggests the importance of the combination of orthostatic dizziness and referred shoulder pain as a diagnostic clue to hemorrhagic gastric ulcer.
