A 47-year-old female with no significant past medical/surgical history presents with two days history of intermittent tarry stools (three times in two days) and progressive lightheadedness. Patient denies fever, chills, nausea/vomiting, or diarrhea.
One month ago, he suffered from upper abdominal pain with shoulder radiation. Biliary pancreatitis was diagnosed at local hospital with ICU admission. After treatment, he was discharged pain free.
On physical exam, pale conjunctiva and hypoactive bowel sounds were noted. There was no abdominal tenderness or rebounding pain. Her stool examinations were positive occult blood. Blood tests showed normocytic anemia. EGD study revealed a 3cm bleeding ulcerative submucosal tumor at the second portion of duodenum.
Abdominal CT showed a 2.7cm enhanced intraluminal mass at the second portion of duodenum
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