Peptic ulcer with visible vessel.
A 66-year-old male was admitted with a history of melena the previous day.
He was hemodynamically stable, and his hemoglobin concentration was 10.2g/dl
with a normocytic picture. Endoscopy revealed an ulcer on the incisura (4a). With
careful inspection, a visible vessel may be seen with a pink, nipple-like
elevation present in the 8 o'clock position on the ulcer. This indicates a
rebleeding risk of up to 50%, unless therapeutic endoscopy is undertaken.
Image 4b is a histological section through a recently bleeding ulcer found
to have a visible vessel on endoscopy. The patient re-bled after admission
to hospital and had a partial gastrectomy. The ulcerated mucosal surface is
uppermost, and the feeding artery can be seen coursing up to the ulcer bed -
where it becomes pseudoaneurysmally dilated and has adherent clot,
resulting in the endoscopic appearance of the visible vessel.
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