A Rare Cause of Obscure Gastrointestinal Bleeding

Abstract

Question: A 33year-old man presented with episodic melena for 3 months associated with worsening exertional dyspnea and lethargy for 2 weeks. Clinical examination revealed marked conjunctival pallor. No masses were felt on abdominal or rectal examination. Hemoglobin level on admission was 3.9 g/dL and red blood cell indices revealed a microcytic and hypochromic erythrocyte profile. The patient received a blood transfusion in view of his symptoms. Esophagogastroduodenoscopy was normal and colonoscopy revealed melenic stains upon intubation of the terminal ileum. Single balloon enteroscopy performed revealed a 2-cm polypoidal lesion with a "strawberry-like" mucosal pattern in the proximal jejunum (Figure A). The lesion was endoscopically tattooed and hemoclips were placed distal to the lesion for future identification. A computed tomography scan of the abdomen showed a 2-cm polypoidal mass in the jejunum with no avid enhancement, calcification, or central necrosis (Figure B). What is the diagnosis of this polypoidal lesion? Look on page 41 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.