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From question on page 1771
Terminal ileoscopy revealed multiple red spots and raised cherry red bumps 3–5 mm in diameter, with a mosaic pattern of the mucosa around their base. Biopsies revealed oedema in the mucosa and arteriolar dilations that sometimes contained fibrin thrombi and were compatible with hypertensive portal ileopathy. Videocapsule endoscopy revealed diffuse involvement of the small intestine, with increasingly severe vascular lesions from the proximal jejunum up to the distal ileum where these particular raised red bumps were exclusively located. All of the lesions were attributed to portal hypertension enteropathy and considered to be the cause of the recurrent gastrointestinal bleeding. The patient was given 80 mg/day propranolol and six months later he no longer exhibited either melena or a relapsing decrease in haemoglobin.
This case exhibited a novel endoscopic appearance of portal hypertensive enteropathy characterised by raised red bumps in the ileum, combined with particular histological features similar to those of gastric antral vascular ectasia.
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