Clinical presentation

A 74-year-old male patient presented with epigastric pain, recurrent melaena and anaemia. His medical history included myocardial infarction, rheumatoid arthritis, diet-controlled type 2 diabetes and recent endovascular infrarenal abdominal aortic aneurysm repair. He was taking aspirin, omeprazole, methotrexate and sulfasalazine. He had stopped smoking for 10 years and was a teetotaller. Upper gastrointestinal (GI) endoscopy did not demonstrate any stigmata of recent haemorrhage. No contrast leak was demonstrated on mesenteric arteriography. CT angiography also did not reveal any contrast extravasation or aortoenteric …