A 31-year-old male presented with repeated episodes of hematemesis for two days. The patient had been previously diagnosed with duodenal ulcer two years back and the ulcer had healed after medical management. He claimed to be non-alcoholic and denied taking any NSAIDs. Physical examination was normal except for pallor and tachycardia. Heart rate- 110/min Hemoglobin 6.8 gm/dl Hematocrit – 20% His nasogastric aspirate was clear and coagulation parameters normal. An upper GI endoscopy was done and the images have been provided.
The duodenal bulb was observed to be deformed and a few clots were found to be adhering to the postbulbar mucosa (A). A repeat endoscopy was done the next day when the patient bled again. It showed active bleeding vessels in postbulbar duodenum though the surrounding mucosa was normal. What can be the possible diagnosis? *This patient case is from Docplexus…
