Open-and-Shut Case: An Uncommon Cause of GI Bleeding
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Case Presentation and Evolution
A 48-year-old man was initially evaluated in the emergency department after acute onset of melena and syncope. He had a self-reported history of attention deficit hyperactivity disorder (ADHD), for which he was not receiving treatment, and methamphetamine use, but his urine toxicology was negative for amphetamines on admission. Moreover, he was actively drinking alcohol, averaging one pint of vodka per day, having consumed alcohol on the day of admission. Prior to the onset of melena, the patient had 2 weeks of epigastric pain without vomiting or hematemesis. He denied a prior history of liver disease, coagulopathy, or gastrointestinal (GI) bleeding.
His initial hemoglobin was 9.3 g/dL (no prior baseline). Other pertinent laboratory values included a white blood cell count of 7.8 × 1000/mcL, platelet count of 184 × 1000/mcL, INR of 1.0, BUN of 25, total protein of 4.5 g/dL, albumin of 2.8 g/dL, total bilirubin of 0.1 mg/dL, direct bilirubin of 0.1 mg/dL,...
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Conflict of interest
The authors declare that they have no conflict of interest.