Ileal ulceration and haematochezia in an 83-year old

An 83-year-old man presented to our institution with anaemia and haematochezia. Bidirectional endoscopy performed 4 weeks prior due to iron deficiency anaemia demonstrated mucosal ulceration at the ileo-caecal valve. Histopathological assessment reveals an acutely inflamed ulcer without granulomata or infectious organism. His medical history included untreated lambda myeloma, chronic hepatitis B infection, ischaemic heart disease and stage III chronic kidney disease. Laboratory tests showed anaemia (haemoglobin of 65 g/L). CT abdomen demonstrated circumferential terminal ileal thickening without active haemorrhage. Inpatient colonoscopy ( figure 1) demonstrated ulceration in the ileum, ileo-caecal valve and caecum without haemorrhage. The patient discharged against medical advice, however, represented with refractory haematochezia with inpatient video capsule endoscopy demonstrating active haemorrhage in the terminal ileum (figure 2). Due to haemodynamic instability, the patient proceeded to ileocolic resection.