Unusual cause of upper gastrointestinal bleeding
A 53-year-old male presented to the emergency room with melena and severe anemia. During the past 6 months, the patient had four episodes of melena. Repeated gastroscopy and colonoscopy revealed no significant pathology. Past medical history included ischemic heart disease, congestive heart failure, insulin-dependent diabetes mellitus, chronic renal failure, peripheral vascular disease and COPD.\nThe laboratory tests showed a hemoglobin level of 6.5 mg/dl, urea 130 mg/dl and creatinine of 3.5 mg/dl. The patient was treated conservatively. An isotopic study with Tc-99 did not reveal any bleeding source. Computed tomography was initially interpreted as normal. A VCE study was performed that identified a submucosal bulge with a central ulceration in the proximal third of the small bowel (Fig. ). More distally in the small intestine melena could be seen by the capsule (Fig. ). Revision of the CT scan confirmed the VCE finding and showed a lesion of fat density in jejunum.\nThe patient was referred to surgery and exploratory laparatomy diagnosed intussusception of jejunum containing an intraluminal submucosal lesion of 5 cm with a superficial ulceration (Fig. ). Segmental resection of the jejunum was performed. Histology confirmed the submucosal lesion to be a lipoma. The postoperative course was uneventful and the patient was discharged on the 6th postoperative day.