Introduction: This is a very interesting case of GI bleeding that is overt but obscure.
Case Description/Methods: A 65-year-old male with HTN, CHF and ESRD presented twice in a span of 6 months with bloody bowel movements. Hb 7 grams/dl. H/O chronic cocaine abuse. EGD and colonoscopy were unremarkable on first admission. There was no blood either old or new in the colon. CTA revealed calcific atheroma of the abdominal aorta without stenosis and normal mesenteric vasculature. There was thickening of the small bowel, however. Capsule endoscopy was planned as an outpatient, but he did not show. A push enteroscopy was performed on the second admission. This revealed multiple ulcerations and an oozing visible vessel that was cauterized with a 7 F Gold probe. Biopsies obtained from the ulcer revealed inflammation only.
Discussion: This case demonstrates the utility of push enteroscopy in the diagnosis of obscure GI bleeding. The cause for this occurrence could be due to vasospasm from cocaine abuse and a low flow state due to CHF.
Disclosures:
Rayburn Rego indicated no relevant financial relationships.
Rayburn Rego, MD. P1799 - The Mysterious Obscure Overt GI Bleed, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
