Overt Gastrointestinal Bleeding Secondary to Nonsteroidal Anti-Inflammatory Drug-Induced Jejunal Diverticular Ulcer

A 72-year-old woman with hypertension, hyperlipidemia, type 2 diabetes mellitus, and chronic back pain was admitted for 3 episodes of large-volume, maroon-colored stools with blood clots. She denied fever, chills, dizziness, shortness of breath, chest pain, palpitations, abdominal pain, nausea, and vomiting. Her past surgical history included cholecystectomy, abdominal hysterectomy, and hernia repair. There was no previous history of gastrointestinal (GI) bleeding. She had been taking ibuprofen chronically for back pain. On presentation, blood pressure was 130/59 mm Hg and heart rate was 81 beats/min without orthostatic changes. Abdominal examination did not reveal any tenderness or organomegaly. Initial laboratory tests revealed hemoglobin 8.1 g/dL, platelet count 254 × 109/L, serum blood urea nitrogen (BUN) 21 mg/dL, and serum creatinine 1.2 mg/dL; other laboratory values were within normal limits. Her baseline hemoglobin, serum BUN, and creatinine the prior month were 8.1 g/dL, 17 mg/dL, and 1.1 mg/dL, respectively