Gastrointestinal bleeding and cutaneous nodules
Alka Mittal, MD, Daniel Felter, MD, S. Michelle Shiller, DO, David McCollum, MD, Jeffrey P. Lamont, MD, and Damien Mallat, MD
Since no abstract is available, the first 150 words of the article are shown.
A 58-year-old man with a past medical history significant for hepatitis C and hypertension was referred to Baylor University Medical Center to evaluate his occult gastrointestinal bleeding with double-balloon endoscopy. Before coming to Baylor, he complained of melena, fatigue, and shortness of breath and had an unrevealing upper endoscopy and colonoscopy. Capsule endoscopy at the outside hospital suggested a proximal bleed in the small bowel. Imaging included an ultrasound that showed a 6-mm common bile duct with cholelithiasis and an angiogram that was nondiagnostic with findings of a proximal jejunal blush suggestive of the site of bleeding. At the outside hospital, he had an initial hematocrit of 23% and received 3 units of packed red blood cells. While his hematocrit rose to 28% with the transfusion, it further declined to 25% and then 23% while being treated with a proton pump inhibitor, and he continued to complain of his initial symptoms.
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