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 22 June 2018

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EndoscopyUpper endoscopy

GI bleeding

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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.


Ken Matthewson, Newcastle upon Tyne, UK

Peptic ulcer with visible vessel.

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