An Unexpected Cause of Recurrent Melena

Question: A 62-year-old man was referred to our hospital with 2 years of recurrent symptomatic melena requiring multiple blood transfusions and iron therapy. His past medical history was not significant. His physical examination was unremarkable and laboratory tests were significant for mild anemia (hemoglobin, 11 g/L; mean corpuscular volume, 96.9 fL). Initial bidirectional endoscopy revealed small amount of hematin stain in the hepatic flexure and mild ileum erythema was found on capsule endoscopy (Figure A).
Source: Gastroenterology - Category: Gastroenterology Authors: Tags: Clinical Challenges and Images in GI Source Type: research