Endoscopy Challenge #3 - May '10

A 7 year old boy with melena and anemia

7yo male with history of Wiskott- Aldrich syndrome, status post cord blood transplant, recently underwent ultrasound guided liver biopsy to evaluate elevated liver associated enzymes and hyperbilirubinemia. Liver biopsy revealed graft versus host disease and adenovirus infection. Approximately 10 days later, patient was readmitted for vomiting, diarrhea, and epigastric abdominal pain. Admission labs showed anemia and abdominal US detected echogenic material in gallbladder lumen. Pertinent physical exam findings included slightly distended abdomen, with epigastric and right upper quadrant tenderness. During hospital stay, patient developed melanotic stools with worsening anemia.

Upper GI endoscopy revealed the following finding: