Case 46221

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Abstract
Presentation of Case* First admission. A fifty-nine-year-old widow entered the hospital because of hematemesis.Fifteen months previously she was admitted to another hospital because of hematemesis and shock, and multiple blood transfusions were given. An upper gastrointestinal series showed a duodenal ulcer, with some obstruction. After the bleeding ceased, she was treated with a medical regimen. Four days before entry persistent epigastric pain and vomiting occurred. During the two days before admission she passed tarry stools, and on the day before entry she vomited blood.Fifteen years previously a cholecystectomy was performed for cholelithiasis. Six years later there was a . . .

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