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Editor's quiz: GI snapshot
A rare cause of upper GI bleeding in a critically ill patient
  1. Christine Walker1,
  2. Sabine Huber-Schumacher2,
  3. Tobias Boettler1,
  4. Robert Thimme1,
  5. Andreas Fischer1
  1. 1 Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
  2. 2 Department of Pathology, University Hospital Freiburg, Freiburg, Germany
  1. Correspondence to Dr Christine Walker, Department of Medicine II, University Hospital Freiburg, Hugstetterstraße 55, Freiburg 79106, Germany; christine.walker{at}uniklinik-freiburg.de

https://doi.org/10.1136/gutjnl-2015-310564

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    See page 1438 for question

    Clinical presentation

    A 60-year-old woman presented with melaena at the intensive care unit 21 days after a complicated coronary artery bypass surgery with intraoperative cardiopulmonary resuscitation. The postoperative course was complicated by prolonged ventilator support and wound infections without signs of severe sepsis or multiorgan failure. She was haemodynamically stable with no significant drop in haemoglobin. Physical examination did not reveal abdominal tenderness, skin or mucosal lesions. Laboratory tests showed mild anaemia (92 g/l; normal range 120–180 g/l) and mild thrombocytopenia (114 × 10*9/l, normal range 140–400 × 10*9/l), and clotting time was unremarkable. Prophylactic anticoagulation was administered.

    Her medical history included arterial …

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    Footnotes

    • Contributors CW and AF performed the endoscopies. SH-S performed histological analysis. CW, TB and AF made the clinical diagnosis. CW, TB, RT and AF wrote the article.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.