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Answers on p 727.
A 77 year old woman with a medical history of peptic ulcer disease and irritable bowel syndrome presented with anEscherichia coli septicaemia secondary to a urinary tract infection, which was treated successfully with intravenous cephalosporins. During her recovery she had an episode of melaena during which her haemoglobin dropped to 67g/l from within the normal range. She was transfused, and was haemodynamically stable. Gastroscopy revealed atrophic gastritis, colonoscopy was normal to the splenic flexure, and a barium enema revealed diverticular disease. She had no further bleeding and was discharged. Four months later she was admitted with a further bleed, she was haemodynamically stable but her haemoglobin had dropped 30 g/l to 88 g/l. At this stage a diagnosis of angiodysplasia was considered but as she was no longer actively bleeding mesenteric angiography was not undertaken. She was transfused and discharged. Three months later she had a third episode of melaena, at this point further gastrointestinal imaging was performed.
At laparotomy there was a small 4 × 2 cm polypoid lesion on the serosal surface of the mid-small bowel. Subsequent histological examination revealed a tumour with a low mitotic rate, composed of both smooth muscle spindles and pancreatic glandular elements; this was consistent with a benign small bowel myoepithelial hamartoma. The patient has remained well and has had no further bleeds.
- What is meant by the term “obscure gastrointestinal haemorrhage” and how would you investigate it?
- What is shown in fig 1?
- Figure 2 shows a laparotomy specimen consisting of a 4 × 2 cm polypoid lesion on the serosal surface of the mid-small bowel. Histologically this is a myoepithelial hamartoma. What are hamartomas?