An 86-year-old man presented to the emergency department with a 2-day history of hematemesis and melena. He had mild ischemic heart disease and was on low-dose aspirin.
The patient was pale with cool and clammy skin. He felt dizzy when attempting to stand up. His pulse rate was 120 bpm and his blood pressure 90/70 mm Hg. Pulmonary and cardiac auscultation revealed no abnormalities. The abdomen was soft and nontender, with slightly increased bowel sounds. On rectal examination, melena was detected.
His hemoglobin level was 80 g/L. Blood studies, including platelet count, prothrombin time, and partial thromboplastin time, were normal. Liver function tests were also within normal limits.
The patient was rapidly stabilized with intravenous fluids, followed by transfusion of packed red blood cells. A gastric lavage was performed, giving incessant exchange of bright red blood through the nasogastric tube.
Urgent endoscopy revealed the following finding on the lesser curvature of the gastric body (Figures 1-3):
(Enlarge Image)
(Enlarge Image)
(Enlarge Image)
What is your diagnosis and how would you manage this patient?
This patient was diagnosed with angiodysplasia with ooze bleeding.
View the correct answer.
<p>This patient was diagnosed with angiodysplasia with ooze bleeding.</p>