Rare

cause of upper gastrointestinal bleeding in a 27-year-old male patient CLINICAL PRESENTATION We report the case of a 27-year-old Caucasian man who was transferred to our hospital due to abdominal pain, bloody stools and haematemesis. The patient had no history of abdominal trauma or surgery and was in good general condition. Physical examination was normal and no signs of liver cirrhosis were evident. Laboratory findings showed marked anaemia (haemo-globin 7.3 g/dl) and slightly elevated levels of g-glutamyl-transferase (114 U/l) and alanine transaminase (86 U/l). An oesophago-gastro-duodenoscopy revealed grade IV oesophageal varices with signs of recent bleeding and several cherry red spots (figure 1A, arrows). In addition, fundic varices (figure 1B, arrow) and signs of portal hypertension were present. Endoscopic liga-tion of oesophageal varices was performed. However, rebleeding occurred and since no signs of underlying liver disease were evident, abdominal CTand angiography were initiated (figure 2) to detect vascular abnormalities. A marked dilatation of the inferior and superior mesenteric artery (IMA and SMA) as well as of veins within the sigmoid and the transverse colon was observed. QUESTION Which differential diagnoses should be taken into account considering the marked vascular alterations within the left colon and which therapeutic approaches would be appropriate