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A 70-year-old man with a medical history of hypertension, coronary artery disease and aortic stenosis (AS) was admitted with symptoms of worsening chest pain and exertional dyspnoea. He also reported melanotic stools and was found to be profoundly anaemic with a haematocrit value of 25%. His last hematocrit a month prior was 36%. Laboratory data revealed normal vitamin B12 and folate levels, but iron levels were consistent with mild iron deficiency anaemia (serum iron 45 μg/dL, transferrin saturation 20% and serum ferritin 68 ng/mL). Stool guaiac test was positive. He underwent an oesophagogastroduodenoscopy, which showed stomach wall coated with old blood with no active bleeding lesions (figure 1A), 10–12 petechial submucosal haemorrhages in the jejunum and active bleeding in the second part of the duodenum (D2; figure 1B). He underwent clipping at the bleeding site (figure 1C). Mesenteric angiogram showed hypervascularity and extravasation seen in the second part of the duodenum supplied by the superior mesenteric and gastroduodenal artery (figure 2A,B). Transthoracic echocardiogram revealed severe valvular AS with aortic valve area of 0.7 cm2, and mean transvalvular gradient of 40 mm Hg. He received 6 units of packed red blood cells. Octreotide infusion …