A patient with long-standing iron-deficient anemia.

BACKGROUND

A 36-year-old Chinese woman presented with cutaneous lupus and was incidentally found to have iron-deficient anemia. She had a history of iron-deficient anemia 13 years previously, for which extensive investigations were carried out; the results of which were all normal. The patient also had pulmonary tuberculosis at that time, for which she received a full course of treatment. She required periodic blood transfusions and iron supplements to maintain her hemoglobin levels. She was subsequently discharged to a family clinic for follow-up until the current presentation.

INVESTIGATIONS: Upper endoscopy, colonoscopy, barium meal follow-through, small-bowel enema, (99m)Tc-labeled red-cell scan and double-balloon enteroscopy.

DIAGNOSIS: Iron-deficient anemia due to obscure gastrointestinal bleeding caused by two small-bowel hemangiomas.

MANAGEMENT: Laparoscopic surgery.