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A 36 year old man was referred to our hospital with signs of gastrointestinal bleeding. He presented with melaena, paleness of the skin, and general weakness, worsening over the last three weeks. Vomiting was absent. The patient has been known to suffer from hyper-IgE syndrome, a primary immunodeficiency disease causing recurrent bacterial infections. During the history of the present illness, the patient described intermittent stool irregularities with dark to black colour without fresh blood for six month as well as painful bowel movements.
Laboratory values were significant for severe anaemia (haemoglobin 5.0 g/dl) and mild elevation of parameters reflecting inflammation (white blood cell count 13 900/µl, C reactive protein 2.8 mg/dl).
The patient underwent gastroscopic examination showing flat healing defects of 4–12 mm in the whole circumference of the descending duodenum as well as thickened folds in this area. The lesions did not present with any signs of bleeding. Therefore, colonoscopy was performed the following day.
What conclusions would you draw from these colonoscopy findings (fig 1)?
See page 1436for answer
This case is submitted by:
Robin Spiller, Editor