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From question on page 1744

All three images show intact mucosa with abnormal spots of red-brown pigment. The three patients were all receiving chronic (over six months) oral ferrous sulphate therapy. Biopsies from these three sites revealed similar feature of marked haemosiderin deposition in the lamina propria with otherwise normal mucosa.

A representative biopsy from the terminal ileum is shown (fig 4) stained with Perl’s Prussian Blue revealing the conspicuous haemosiderin deposition (blue staining) in the tips of two of the villi in the field.

Despite many patients being on chronic oral iron supplementation, such endoscopic images are relatively rarely observed and are poorly documented in the gastrointestinal literature.

Figure 4

 Biopsy of the terminal ileum.

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