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Case 96

Unusual cause of gastrointestinal bleeding

Erica Buurman, Richard Edwards

A 54 year old man was admitted with a 1-day history of significant melaena associated with mild epigastric pain. His past history included ischaemic heart disease, chronic renal failure (treated by peritoneal dialysis) and aortic aneurysm repair 3 years previously. His haemoglobin on admission was 8.8 g/dl with a white cell count of 12.8. Upper gastro-intestinal (GI) endoscopy to the second part of the duodenum showed no source of bleeding. He was referred for visceral arteriography because of continued melaena. During the procedure his systolic blood pressure remained below 90 mmHg.

What does the arteriogram show?