Obscure Gastrointestinal Bleeding:A Diagnostic Dilemma?

Abstract

We present a case of obscure gastrointestinal bleeding with the clinical presentation of hematemesis and melena. The patient was a 68-year-old man who complained of recurrent upper gastrointestinal bleeding and was presented with hematemesis and melena. He had no history of abdominal vascular reconstructive surgery, peptic ulcer disease, or any other diseases. On physical examination, the patient looked anemic with pale skin and was in an altered hemodynamic state. His vital signs were unstable.  Heart and lungs examinations were normal. There was no scar on the abdomen. Epigastrium was tender on palpation without any organomegaly. He was admitted with the clinical presentation of upper gastrointestinal bleeding with hematemesis and melena. Laboratory evaluation, including blood tests, showed anemia. Emergency upper and lower endoscopy did not find a bleeding source. Total colonoscopy with terminal ileal intubation was negative. Abdominal and pelvic computed tomography (CT) with and without contrast showed a 5-cm saccular aneurysmal mass around the bifurcation of the abdominal aorta that was associated with mural thrombosis and was extended to proximal common iliac artery. The second part of the duodenum was attached to the upper border of the aneurysmal mass with suspicious communication between the aorta and the small intestine.