2016-01-13 15:07:23 UTC

Image Challenge: Obscure Gastrointestinal Bleeding

Jan. 13, 2016

The patient's colonoscopy revealed melenic stains upon intubation of the terminal ileum.

Question: A 33-year-old man presented with episodic melena for three months, associated with worsening exertional dyspnea and lethargy for two weeks. A clinical examination revealed marked conjunctival pallor. No masses were felt during the abdominal or rectal examinations. The patient's 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.

EGD was normal and colonoscopy revealed melenic stains upon intubation of the terminal ileum. A single balloon enteroscopy 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.

What's the diagnosis of this polypoidal lesion? Find out the answer in Gastroenterology

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