A rare cause of GI bleeding in a patient with cutaneous vascular malformations

Clinical presentation A 53-year-old woman with a background of chronic bronchitis was admitted with an infective exacerbation of chronic obstructive pulmonary disease. Her medical history included atrial septal defect (ASD) and ventricular septal defect (VSD) repair in childhood and a recent deep vein thrombosis, for which she was on rivaroxaban. On examination, she had multiple blue pigmented soft tissue lesions on her face, tongue, torso and hands (figures 1 and 2). During her admission, the patient developed melaena associated with a significant acute drop in her haemoglobin (Hb). She was treated with prothrombin complex concentrate, blood transfusion and discontinuation of rivaroxaban. Initial investigation with a gastroscopy and colonoscopy was normal but an abdominal CT angiogram suggested active bleeding in the proximal jejunum. Emergency angiography and embolisation successfully controlled the bleeding. A small bowel capsule endoscopy (SBCE) was subsequently performed, which revealed multiple vascular polypoid...

Source: Gut - October 6, 2016 Category: Gastroenterology Authors: Tsoutsouki, J., Laskaratos, F.-M., Mason, S., Smith, M., Sinha, L. Tags: GUT Snapshot Editor ' s quiz: GI snapshot Source Type: research