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Gut. 2007 November; 56(11): 1528.
PMCID: PMC2095639

Upper gastrointestinal bleeding with a difficult endoscopy

Clinical presentation

An 84‐year‐old man presented at our institution with tarry stools and epigastric pain for 1 day without nausea or vomiting. A medical history included a percutaneous coronary angioplasty (2 years previous) and chronic obstructive airways disease. On physical examination, the patient demonstrated mild tenderness in the epigastrium; however, no mass was palpable. Laboratory data revealed mild normocystic and normochronic anaemia (Hb 11.3 g/dl and Hct 32.9%). A plain abdominal x ray showed a normal gas pattern. An upper gastrointestinal endoscopy revealed a giant fold invaginated into the pyloric orifice originating from halfway down the lesser curvature of the stomach. This prevented the advancement of the endoscope as well as visualisation of the antrum (fig 11).). A barium meal examination revealed a dilated stomach and an intramural mass lesion over the bulb of the duodenum (fig 22).

figure gt106559.f1
Figure 1 Endoscopy revealed a giant fold invaginated into the pyloric orifice from the lesser curvature side of the middle body.
figure gt106559.f2
Figure 2 A barium meal examination revealed a dilated stomach and an intramural mass lesion over the bulb of the duodenum (arrow).

Question

What is the diagnosis?

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