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Abdominal pain and melaena: an unusual cause

Godkin, Andrew James, Thompson, Mary and Summerfield, John 2000. Abdominal pain and melaena: an unusual cause. The Lancet 356 (9229) , pp. 562-563. 10.1016/S0140-6736(00)02582-4

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Abstract

A 69-year-old Irish woman presented with a 3 week history of abdominal pain, vomiting, and intermittently dark loose stool. Similar episodes, with weight loss, had occurred over the previous 8 years, but investigations had revealed only colonic diverticulosis. Medical history included cholecystectomy, hysterectomy, and appendicectomy. She had longstanding hypertension, ischaemic heart disease, hypercholesterolaemia, and chronic renal impairment thought to be related to hypertensive nephropathy (previous serum creatinine had reached 300 μmol/L). She was an ex-smoker and was taking ramipril, simvastatin, aspirin, and omeprazole (none started within 2 months). On examination she was overweight with modest peripheral oedema. She was pale, blood pressure was 90/60 mm Hg and pulse 110 beats per minute. Her abdomen was soft with mild epigastric tenderness. Rectal examination showed melaena. She had a normocytic anaemia (haemoglobin 10·8 g/L), neutrophilia (9·1×109/L), lymphopenia (0·7×109/L), and thrombocytosis (platelets 712·109/L). Serum creatinine was 383 μmol/L and urea 49·5 mmol/L. Serum electrolytes, amylase, iron, folate, vitamin B12, blood gas analysis, and clotting screen were normal. She initially improved with intravenous fluids, creatinine falling to 315 μmol/L. At oesophagogastroduodenoscopy (OGD) the first and second parts of the duodenum showed uniform gross inflammation. The inflammation ended abruptly in the third part of the duodenum (figure). Histology from the inflamed area showed an underlying necrotising vaculitis.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Systems Immunity Research Institute (SIURI)
Subjects: R Medicine > R Medicine (General)
Publisher: Elsevier
ISSN: 0140-6736
Last Modified: 04 Jun 2017 07:51
URI: http://orca.cf.ac.uk/id/eprint/68888

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