Rare cause of upper gastrointestinal bleeding in a 27-year-old male patient
- Dominik Bettenworth1,
- Emile Rijcken2,
- Klaus-Michael Müller3,
- Angelika Mosch-Messerich4,
- Jan Heidemann1
- 1Department of Medicine B, University of Münster, Münster, Germany
- 2Department of General Surgery, University of Münster, Münster, Germany
- 3Gerhard Domagk Institute of Pathology, University of Münster, Münster, Germany
- 4Department of Radiology, St. Willibrord-Spital Emmerich-Rees, Emmerich, Germany
- Correspondence to Dr Dominik Bettenworth, Department of Medicine B, University of Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany; dominik.bettenworth{at}ukmuenster.de
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Contributors DB and JH wrote the manuscript. ER provided intraoperative pictures. K-MM performed histological analysis and provided pictures of surgical specimens. AM-M provided scans of abdominal CT and angiography.
- Accepted 2 February 2012
- Published Online First 8 March 2012
- Arteriovenous fistula
- inferior mesenteric vessels
- oesophageal varices portal hypertension
- ischaemic colitis
Clinical presentation
We report the case of a 27-year-old Caucasian man who was transferred to our hospital due to abdominal pain, bloody stools and haematemesis. The patient had no history of abdominal trauma or surgery and was in good general condition. Physical examination was normal and no signs of liver cirrhosis were evident. Laboratory findings showed marked anaemia (haemoglobin 7.3 g/dl) and slightly elevated levels of γ-glutamyltransferase (114 U/l) and alanine transaminase (86 U/l). An oesophago-gastro-duodenoscopy revealed grade IV oesophageal varices with signs of recent bleeding and several cherry red spots (figure 1A, arrows). In addition, fundic varices (figure 1B, arrow) and signs of portal hypertension were present. Endoscopic ligation of oesophageal varices was performed. However, rebleeding occurred and since no signs of underlying liver disease were evident, abdominal …
