Bleeding duodenal ulcer
Admitted post mechanical MVR and CABG. Recurrent upper GI bleeding and known duodenal ulcer. Ongoing melena dropped Hb from 90 to 62 despite two units of PRBC; tachycardia, increased norepinephrine.
CT Abdomen and Pelvis (GI bleed protocol)
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There is active contrast blush within the second portion of the duodenum associated with diffuse duodenal wall thickening. No other hemorrhagic foci identified. Bowel has otherwise unremarkable appearances, with normal mural enhancement. No free fluid or free gas in the peritoneal cavity.
Focal metallic surgical material within the right colon posterior wall. Apart from a simple cyst in the segment VII, liver has normal appearances. The gallbladder, pancreas, adrenal glands, spleen, and kidneys appear unremarkable. Left femoral venous catheter in situ with the tip in the left common iliac vein. Diffuse subcutaneous edema (anasarca). No suspicious bone lesions. Bilateral pleural effusions, with loculated appearances on the right.
This case illustrates active duodenal bleeding due to an ulcer (previously diagnosed on endoscopy).