Test your clinical knowledge with the daily Case in Point program, which gives you the opportunity each weekday to work through a subspecialty case.

CASE OF THE DAY

A 67-year-old man with multiple medical comorbidities including a history of prostate cancer presented to the hospital in hypovolemic shock following multiple episodes of melena and coffee ground emesis, which was responsive to fluid management. After laboratory workup, he was found to be anemic with a hemoglobin of 5.9 g/dL. Because of concerns of gastrointestinal bleed, the patient underwent upper endoscopy in which a 3-cm duodenal bulb ulceration that extended into the second part of the duodenum was identified. Following the procedure, the patient remained unstable with continued desaturations. He was hypotensive and tachycardic, requiring multiple packed red blood cell transfusions and aggressive hemodynamic support. On day 17 of his hospital stay, the patient acutely decompensated, and interventional radiology was consulted for emergent intervention.