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Volume 87 - 2024 - Fasc.1 - Clinical images

A lower gastrointestinal bleeding in a haemodialysis patient as a potential precursor of small bowel ischaemia

A 77-year-old man presented with anorexia, nausea, vomiting and bloody diarrhoea. The patient had a past medical history of heart transplantation, multiple myeloma and chronic kidney disease (CKD) requiring haemodialysis. Clinical examination revealed a diffusely tender abdomen. His vital signs included a low blood pressure of 80/55 mmHg, tachycardia of 112 bpm, normothermia (36.2°C) and a SpO2 of 97% when breathing room air. Laboratory studies were significant for haemoglobin 13 g/dL (16 g/dL a few days earlier), CRP 179,8 mg/L, leukocyte count 13,75 x10E3/μL, lactate 4,46 mmol/L and known CKD. A multiphasic contrast-enhanced abdominal computed tomography did not show any acute pathology, nor vascular contrast extravasation.


Out of place, not out of mind

We present endoscopic images of two different patients who underwent upper gastrointestinal endoscopy. The first image (Figure 1A) comes from a 45-year-old female with a history of epigastric pain, responsive to proton pump inhibitors (PPIs), and no significant medical history. The second image (Figure 1B) shows the oesophagus of a 63-year-old male with regular alcohol consumption and experiencing heartburn. Both patients were treated with pantoprazole 20 mg daily. The endoscopic findings were unremarkable, except for the oesophageal lesions shown here.