Medical Case Details:
A 25-year-old Caucasian male with a history of arterial hypertension for more than 10 years presented with chronic intermittent abdominal pain and recent onset gastrointestinal bleeding symptoms. He has been self-medicating with captopril 25 mg only when symptomatic and has not had regular medical follow-up for over eight years. His past medical history is significant for severe dengue hemorrhagic fever more than 10 years ago. He has been living in Serbia for more than one year.
The patient reported intermittent right upper and mid abdominal pain for nearly five years, which reportedly started after the dengue episode. The pain was occasionally colicky, not clearly related to meals, and generally tolerable without the need for regular analgesics. Associated symptoms included alternating bowel habits, bloating, nausea, postprandial fullness, and excessive gas.
Over the last four months, he developed more intense epigastric and left upper abdominal pain along with marked nausea and persistent gastrointestinal symptoms. He also experienced an episode of hematochezia with blood clots and mucus. Occasional dark urine was reported, although there were no other urinary complaints or respiratory symptoms. The patient also described intermittent palpitations and tachycardia, though these were not documented.
Multiple ECGs showed normal sinus rhythm, and cardiac enzymes were repeatedly normal. Abdominal examination was soft and non-tender without organomegaly. Stool occult blood test was positive, while stool examination for ova and parasites was negative. Laboratory investigations revealed AST 35 U/L, ALT 68 U/L, GGT 35 U/L, amylase 112 U/L, and lipase 78 U/L.
The patient had previously been evaluated by internal medicine and surgery teams without a definitive diagnosis. Gastroenterology consultation had been done, but no endoscopic evaluation had been performed so far. Family history was significant for hypertension in the mother and childhood renal cancer in a niece.
Given the persistent gastrointestinal symptoms, positive fecal occult blood, and episode of hematochezia without a clear infectious or parasitic cause, further evaluation was considered necessary. The major discussion points included whether to prioritize colonoscopy and upper GI endoscopy, cross-sectional imaging, inflammatory bowel disease work-up, or evaluation for possible post-infectious or vascular gastrointestinal pathology.