ABSTRACT
A 16-year-old Caucasian woman presented to the emergency department complaining of abdominal pain and vomiting. She described a 4-day history of coffee ground vomiting 3–4 times daily. Over the last day, she had developed severe abdominal pain radiating from the loin to the groin on the right side. Her past history included idiopathic thrombocytopenic purpura (ITP) diagnosed when she was 4 years of age, menorrhagia, several presentations with renal colic in the past 5 years, migraines associated with menstruation and longstanding intermittent haematuria. On direct questioning, the patient described multiple episodes of haematemesis occurring every few months since she was approximately 12 years of age. She took no regular medications. There were no known familial illnesses. She lived with her parents and was in full-time education. She denied smoking or alcohol intake.
