No abstract

A 74-year-old woman was admitted because of dark stools in the last four days. She suffered from atrial fibrillation, had two heart valves implanted (mitral and aortic), and was under anticoagulant therapy with acenocumarol. The most remarkable laboratory findings were hemoglobin 9.2 g/dl, hematocrit 26.8%, mean corpuscular volume 94.2 fl, and blood urea 80 mg/dl. Prothrombin time was 28% and INR 2.65. An esophago-gastro-duodenoscopy was performed. Blood was observed in the second duodenal portion, perhaps in the papillary area, although no definite source was found. The routine forward-view gastroscope was exchanged for a side-view duodenoscope. Blood was seen oozing out the papilla (Figs. 1 and 2). Conservative measures were taken using blood transfusions and venous fluid supply. Magnetic resonance cholangiopancreatography and abdominal magnetic resonance angiography revealed only cholecystolithiasis and no vascular abnormalities. The patient did well without rebleeding, and she was discharged.