Case Presentation: A 49-year-old male presented with shortness of breath, fatigue and four weeks of dark stools. He had previously been diagnosed with IgG lambda multiple myeloma (MM) with renal insufficiency and hypertension. He had MM disease progression despite completing chemotherapy and had declined further treatment. Physical exam revealed an ill-appearing, pale mane with a [...]

Case Presentation: An 80 year-old female presented to the emergency room with shortness of breath and melena. She was afebrile, with blood pressure of 121/70 and heart rate 93. Labs showed hemoglobin of 5.2 g/dL with normal INR and platelet count. She underwent an upper endoscopy revealing a 2 mm clean-based duodenal ulcer. As this [...]

Case Presentation: 47-year-old male veteran presented with one-month history of intermittent left-sided abdominal pain, vomiting, constipation and melena. Abdominal X-ray revealed small bowel obstruction. CT scan of the abdomen and pelvis with contrast revealed multifocal masses involving proximal to mid-small bowel with small bowel obstruction secondary to the mass at the level of jejunal and [...]

Case Presentation: Patients presenting with melena are often found to have an upper gastrointestinal source: melenic stool on exam has a likelihood ratio of 25 for upper gastrointestinal bleed (1). But what if repeated endoscopies are unimpressive? Mr. S is a 75 year old male with a history of atrial fibrillation on apixaban for three [...]

Case Presentation: A 49-year-old male with history of cirrhosis and hepatocellular carcinoma secondary to alcohol use and alpha-1 antitrypsin deficiency, who underwent liver transplant 1 month prior that was complicated by a bile leak at the biliary anastomosis requiring stenting, presented to the hospital for sudden onset of fever, chills and headaches. He was on [...]

Case Presentation: A 68-year-old male with 6-months history of dark stools, lightheadedness, and fatigue. He was not on blood thinners. He had three ED visits, two hospitalizations and several office visits and received seven units of packed red blood cells (PRBC) during that time for iron deficiency anemia. Extensive workup with upper GI endoscopy (EGD) [...]

Case Presentation: A 69-year-old male with a complex medical history including coronary artery disease, abdominal aortic aneurysm, and polyarthralgia was hospitalized for treatment of lower extremity necrotizing fasciitis and refractory ulcers. During hospitalization, the patient developed intermittent melena. Upper endoscopy was unremarkable. Contrast-enhanced CT revealed biliary dilation with evidence of blood in the biliary system [...]