Dr. James J. Pollard: This roentgen film (Fig 1) is part of an emergency upper gastrointestinal series done for a 64-year-old white housewife with hematemesis. She had begun to experience occasional epigastric and right upper quadrant pain 10 years prior to admission. A cholecystectomy had been done for cholelithiasis 2 years previously, with remission of her fatty food intolerance and right upper quadrant symptoms.
Two weeks prior to admission the patient noted an increase in severity and frequency of the epigastric pain, which was not associated with food or relieved by ingesting an alkali compound. The day before admission she noted melena and vomited one or two cupfuls of dark red blood. She denied excessive intake of alcohol, weight loss, anorexia, and symptoms of liver disease. She had been moderately hypertensive.
Physical examination showed a pale, obese female who vomited blood from time to time and passed melenic stools. Her
Griscom NT. An Unusual Cause of Acute Hematemesis. JAMA. 1963;186(8):790–791. doi:10.1001/jama.1963.63710080021013
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