A 56-year-old female with no significant past medical/surgical history presents with 1 month history of intermittent tarry stool passages and progressive lightheadedness. She denied fever, cough, weight loss, or any abdominal discomfort. Initial TPRs were as follows: 36C/108/22; BP 131/51mmHg. On physical exam, pale conjunctiva and hypoactive bowel sounds were noted. There was no abdominal tenderness or rebounding pain. She had a positive FOBT. Blood tests showed severe anemia (Hb 3.9g/dL). EGD showed only DU scar at AW with positive CLO test, and colonscopy showed only internal hemorrhoid. Her symptoms subsided after component therapy and H. pylori eradication with triple therapy was then administered at our GI clinic.
Symptoms recurred, and she was admitted to our ward. Patient subsequently received a series of examinations. Laboratory examinations, abdominal CT, and small bowel enteroscopy shows as below.
A large heterogeneously enhancing mass 8.3x8.2 cm noted in the pelvis attached closely to the small bowel and uterus with engorged mesenteric vessels noted around the intestinal wall of small bowel.
Small Bowel enteroscopy (Video)
Video Link
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