Question: A 56-year-old man was admitted to our emergency department because of a transient loss of consciousness. He had been suffering from dizziness and melena for two weeks and denied any use of nonsteroidal anti-inflammatory drugs or anticoagulants. At admission, he appeared pale and had mild tachycardia (heart rate 110 bpm). Physical examination revealed pale conjunctiva and abdominal distension without tenderness or palpable abdominal mass. Laboratory tests including tumor markers were unremarkable except for anemia (hemoglobin, 46 g/L [normal, 120–160]; hematocrit, 14.5% [normal, 38%–50%]).