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A 50 year old White man with cirrhosis due to hepatitis C virus (HCV) infection was admitted to our hospital for severe anaemia and intermittent melena. At admission, haemoglobin was 6 g/dl. Upper endoscopy disclosed grade 1 oesophageal varices, no gastric varices, and severe portal hypertensive gastropathy with a mosaic-like pattern in the fundus and confluent cherry red spots compatible with gastric antral vascular ectasia in the antrum. Transvenous liver biopsy confirmed HCV related cirrhosis, and the hepatic venous pressure gradient was 9 mm Hg. Despite the transfusion of 3 units of packed red cells, intermittent melena persisted and haemoglobin continued to decrease. Ileocolonoscopy disclosed a normal colon without hypertensive colopathy but terminal ileoscopy revealed particular lesions (fig 1).
What is the nature of these ileal lesions? Are they related to the cirrhosis?
See page 1780 for answer
This case is submitted by:
Robin Spiller, Editor