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A 59-year-old woman presented to the emergency department of a hospital with tertiary hepatology services reporting upper abdominal pain and black stools. She was known to have alcohol-related cirrhosis (Child Pugh A6) under routine hepatology follow-up, and was an active drinker. Medical history included hypertension, hypothyroidism and a Roux-en-Y (RNY) gastric bypass for obesity 10 years previously.
The patient was tachycardic but normotensive with melaena on digital rectal examination. Haemoglobin was 98 g/L from 148 g/L preadmission (reference range 115–55 g/L). Glasgow Blatchford Score was 9. She was fluid resuscitated and broad-spectrum antibiotics and terlipressin administered. An emergency oesophagogastroduodenoscopy (OGD) identified grade 1 oesophageal varices with no high-risk stigmata of bleeding. There was no fresh or altered blood in …
Correction notice This article has been corrected since it published Online First. Figure one has been moved to the question section of the content.
Contributors All authors were involved in the clinical care of the patient and identifying the case as appropriate for submission. JH reviewed the literature and wrote the article. JAL, TCS and GC critically reviewed manuscript drafts and approved the final article for submission. SU selected the images and wrote the captions. JH and JAL are responsible for the overall content as guarantors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.