Case 49-1977

Presentation of CaseA 69-year-old woman was admitted to the hospital because of melena.Twenty years earlier a diagnosis of hypothyroidism was made, and desiccated thyroid, 3 g daily, was prescribed. Eleven years before admission she first noted mild dyspnea. Four years before entry she was admitted to another hospital because of melena. Examination disclosed a murmur and signs of mild congestive heart failure. Extensive studies, including an exploratory laparotomy, failed to disclose a source of bleeding. Three years before admission bleeding recurred, and she came to this hospital, where she underwent a vagotomy, a partial gastrectomy with a Bilroth . . .