Clinical presentation

A 53-year-old white European male builder presented emergently with haematemesis and melaena. Four months previously, he underwent an exploratory laparotomy, small bowel resection and anastomosis for a spontaneous jejunal perforation. His immediate postoperative course was uneventful. One month prior to this admission he lost the sight in his right eye because of a central retinal vein occlusion (CRVO): blood cultures, vasculitis and thrombophilia screens were negative and an echocardiogram and carotid Dopplers unremarkable. There was no significant family history. For the treatment of his CRVO, he was taking 15 mg of prednisolone daily and 150 mg of aspirin. He consumed 14 units of alcohol per week …