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Gut 2009;58:1605 doi:10.1136/gut.2009.179341
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An unusual cause of obscure gastrointestinal bleeding

  1. C-M Tai1,2,
  2. H-P Wang3,
  3. J-C Hwang4,
  4. T-C Lee3,
  5. C-T Lee1,
  6. J-T Lin1
  1. 1
    Departments of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
  2. 2
    Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  3. 3
    Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
  4. 4
    Departments of Pathology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
  1. Correspondence to Dr J-T Lin, Department of Internal Medicine, E-Da Hospital and I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen,Yan-Chau Shiang, Kaohsiung County 824, Taiwan; jawtown{at}ntu.edu.tw

    Clinical presentation

    A 52-year-old man with end-stage renal disease and cirrhosis suffered from intermittent passage of melena of 2 months’ duration. Oesophagogastroduodenoscopy and colonoscopy did not reveal a bleeding lesion. He was referred to our hospital for balloon-assisted enteroscopy because of obscure gastrointestinal bleeding (OGIB). The laboratory findings were as follows: haemoglobin, 8.2 g/dl (normal range, 12.0–16.0 g/dl), platelet count, 102×103/μl (normal range, 150–400×103/μl), prothrombin time, 9.7 s (control, 10.6 s; international normalised ratio (INR), 0.91), activated partial thrombin time, 25.7 s (control, 31.3 s). Balloon-assisted enteroscopy via the oral route revealed …

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