Strange coincidence in the gut: pseudomelanosis duodeni diagnosed by capsule endoscopy and active bleeding due to angiodysplasia.

We present the case of an 82-year-old male with a medical history of hypertension, dyslipidemia, diabetes mellitus, chronic renal failure, ischemic heart disease and iron deficiency anemia. He was under therapy with hydralazine, furosemide, amlodipine, valsartan, nitroglycerin patches, bisoprolol, omeprazole, doxazosin, human insulin and oral iron. The patient presented at our institution with melena. Initial gastroscopy showed fresh blood and a gastric angiodysplasia that was treated with argon plasma coagulation (APC). Three months later, he suffered a new episode of bleeding and a small bowel capsule endoscopy (SBCE) was subsequently indicated.