A rare cause of gastrointestinal bleeding: Endoscopic venous malformations, but not vasculitis

摘要

A 24-year-old woman with no medical history presented with sharp right upper quadrant (RUQ) pain and nausea of 1-day duration. Patient reported generalized fatigue but no fever, or change in appetite or stools. Patient reported smoking two cigarettes daily but no alcohol use. On examination, patient was febrile (101 °F) and abdomen was soft, significantly tender in RUQ, with no hepatosplenomegaly or peritoneal signs, normal bowel sounds, and normal rectal exam without any blood. She had few small, blue colored, non-blanching macules on her trunk since childhood. Labs showed normal leukocytes, platelets, coagulation parameters; hemoglobin 7g/dL, with iron studies suggestive of iron-deficiency anemia. CT abdomen revealed intramural hemorrhage in duodenum. Fig. 1 represents the endoscopic finding. Similar lesions were seen in other areas of duodenum and colon.