An unusual cause of obscure gastrointestinal bleeding in a patient with cirrhosis
- 1Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- 2Department of Radiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- 3Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- 4Department of Pathology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- 5Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Correspondence to Professor Jaw-Town Lin, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; jawtown{at}gmail.com
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Contributors All authors contributed to the Editor's quiz.
- Accepted 26 April 2012
- Published Online First 22 May 2012
- Varix
- small intestine
- obscure gastrointestinal bleeding
- cirrhosis
- ventral hernia
- obesity
- endoscopy
- abdominal MRI
Clinical presentation
A 59-year-old woman with hepatitis C virus-related cirrhosis and oesophageal varices underwent laparotomy and right salpingo-oophorectomy for right ovarian fibroma, 6 months prior to this admission. The pre-operative CT scan, for the assessment of the ovarian fibroma revealed, incidentally, subcutaneous umbilical collateral vessels (figure 1A). A ventral hernia developed 3 months after the surgery, and the size of the hernia sac enlarged progressively. The patient was admitted because she passed bloody stools the day before admission. On admission, the physical examination revealed collateral veins and a soft bulging mass in the lower abdomen. The laboratory examination revealed: haemoglobin, 7.1 gm/dl …
