An Unusual Cause of Gastrointestinal Bleeding

Abstract

Question: A 69-year-old woman was referred to our intensive care unit (ICU) of Hepatology and Gastroenterology for melena. Medical history included appendicectomy, hysterectomy for fibroma, and non-bleeding gastric ulcer 1 year earlier. She was an active smoker (25 pack-years). She suffered from arthralgia and so took anti-inflammatory drugs. A few weeks later, she presented with melena and was consequently referred to our ICU. At admission, patient’s blood pressure was 110/70 mmHg and heart rate 98 bpm. Physical examination was normal except for anemia-related symptoms. Biological examinations showed a hemoglobin level of 6 g/dL. Initial upper endoscopy and colonoscopy were normal. Capsule endoscopy was performed and showed fresh blood in the small bowel. Abdominal computed tomography revealed contrast extravasation in the small bowel lumen, 1 m beyond the ligament of Treitz. Hence, an upper push enteroscopy was performed and revealed a bleeding tumor in the proximal jejunum (Figure A). The patient required 21 units of blood altogether. Operative resection was performed. Anatomopathologic examination showed a 5-cm,