Dark colored duodenum: Has anyone dimmed the scope light? A
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A 43-year-old female with a past history of type II diabetes mellitus, hypertension, non-ischemic cardiac myopathy, end stage renal disease on hemodialysis and hypothyroidism presented to the emergency department with nausea, hematemesis and melenic stools for three days. She reported occasional naproxen ingestion for joint pain. She denied any previous episodes of similar gastrointestinal bleeding or any oral iron supplementation. Blood work was significant for 2-gram drop in her hemoglobin. An urgent esophagogastroduodenoscopy (EGD) revealed a gastric ulcer with a visible vessel in its base and black pigmentation involving the 2nd part of duodenum. The antral ulcer was treated with epinephrine injection and gold probe cautery. Biopsies were obtained from both the stomach and the duodenum. Gastric biopsies showed chronic active gastritis with immunostaining positive for Helicobacter pylori. Biopsies from duodenum revealed duodenal villi with prominent pigment. Special staining highlighted iron-containing pigment that is consistent with pseudomelanosis duodeni (PMD). The patient was treated for H. pylori infection with triple therapy...

http://www.edoriumjournals.com/journal-of-case-reports-and-images-in-medicine/archive/2017-archive/100032Z09HS2017-saraireh/100032Z09HS2017-saraireh-full-text.php
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