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Case Records of the Massachusetts General Hospital
Weekly Clinicopathological Exercises
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Volume 341:1063-1071 September 30, 1999 Number 14
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Case 30-1999— An 86-Year-Old Man with Gastrointestinal Bleeding and Small Bowel Obstruction
Dominic J. Nompleggi, and Henry Y. Dong

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Presentation of Case

An 86-year-old man was admitted to the hospital because of gastrointestinal bleeding with abdominal pain.

The gastrointestinal bleeding had begun a year and a half earlier. The patient was hospitalized at that time because of several episodes of hematochezia and iron-deficiency anemia, with a hematocrit of 26 percent, while he was taking warfarin for the treatment of dilated cardiomyopathy. Laboratory tests were performed (Table 1). Colonoscopic examination and an esophagogastroduodenoscopic study showed no important lesions. The patient was discharged with prescriptions for warfarin and ferrous sulfate, in addition to his other medications.

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Table 1. Immunologic Findings 18 Months before Admission.

 
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Differential Diagnosis

Clinical Diagnosis

Dr. Dominic J. Nompleggi's Diagnosis

Pathological Discussion

Anatomical Diagnosis

References




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