Presentation of Case A 25-year-old man was admitted to the hospital because of hematemesis. He was well until one year earlier, when upper gastrointestinal tract bleeding developed, and the patient was informed of hepatic enlargement; no medical follow-up was arranged. The patient was well thereafter except for fatigue during the several weeks preceding entry. One day before admission the patient became nauseated. That evening he vomited brightred clots of blood. He was taken by ambulance to another hospital; he continued to vomit large volumes of fresh blood en route and was lethargic but arousable; saline solution was infused by vein.
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