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Obscure gastrointestinal bleeding occurring 50 years after an appendectomy
  1. Shin Kashima1,
  2. Toshie Nata1,
  3. Mikihiro Fujiya1,
  4. Kentaro Moriichi1,
  5. Yoshiki Nomura1,
  6. Nobuhiro Ueno1,
  7. Kentaro Itabashi1,
  8. Chisato Ishikawa1,
  9. Yuhei Inaba1,
  10. Takahiro Ito1,
  11. Kotaro Okamoto1,
  12. Yusuke Mizukami1,
  13. Yoshiaki Ebisawa2,
  14. Naoyuki Chisato2,
  15. Toru Kohno2,
  16. Yoshihiko Tokusashi3,
  17. Naoyuki Miyokawa3,
  18. Masataka Yamada4,
  19. Yutaka Kohgo1
  1. 1Department of Medicine, Asahikawa Medical College, Asahikawa, Japan
  2. 2Department of Surgery, Asahikawa Medical College, Asahikawa, Japan
  3. 3Surgical Pathology Department, Asahikawa Medical College Hospital, Asahikawa, Japan
  4. 4Internal Medicine, Shibetu City Hospital, Shibetu, Japan
  1. Correspondence to Dr Mikihiro Fujiya, Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College, 2-1 Midorigaoka-Higashi, Asahikawa, Hokkaido 078-8510, Japan; fjym{at}asahikawa-med.ac.jp

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Clinical presentation

A 69-year-old male, with a history of an appendectomy 50 years previously, presented to hospital due to refractory dizziness and bloody stool. A routine blood test revealed that he had severe anaemia. Upper and lower endoscopy revealed no evidence of bleeding in the oesophagus, stomach, duodenum, terminal ileum or colorectum. He was diagnosed as having obscure gastrointestinal bleeding.1 Capsule endoscopy (CE) was performed and dark-bluish areas with whitish villi were detected in the jejunum (figure 1). Subsequently, double-balloon endoscopy (DBE) was performed orally and multiple dark-bluish areas coated with whitish villi were found at the distal jejunum (figure 2A), and white debris also oozed from …

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