Electronic Clinical Challenges and Images in GI A Very Obscure Gastrointestinal Bleeding Carlo M. Girelli, Barbara Nardo, and Giordano Bernasconi Department of Internal Medicine, Service of Gastroenterology and Digestive Endoscopy, Hospital of Busto Arsizio, Busto Arsizio, Italy Question: A 62-year-old man was referred to our unit for intermittent obscure– overt gastrointestinal bleeding for 2 months requiring up to 3 units of packed red blood cells weekly. His clinical history was noteworthy for urgent right hemicolec- tomy owing to right-sided colonic diverticulitis 8 years before this admission. Upper and lower endoscopy and angiography were negative. On admission, he presented with melena; he was hemodynamically stable and his hemoglobin level was 68 g/L. After red blood cell replacement, he underwent small bowel capsule endoscopy disclosing a tiny, round, bulls-eye shaped mucosal break, located in the mid small bowel (52% of the time elapsed from the pylorus; Figure A, arrows). What is the diagnosis? See the GASTROENTEROLOGY web site (www.gastrojournal. org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Conﬂicts of interest: The authors disclose no conﬂicts. © 2012 by the AGA Institute 0016-5085/$36.00 doi:10.1053/j.gastro.2011.09.007 GASTROENTEROLOGY 2012;142:e3– e4