Upper Gastrointestinal bleeding secondary to an enormous hairball

A 17- year- old female high school student, with no remarkable medical history, presented to the emergency department with hematemesis and melena. She reported anorexia, weakness and a mild chronic epigastric pain during the last three months, with unrecorded weight loss. At presentation, the patient was thin. She had no apparent depressive or psychotic symptoms. Her physical examination showed stable vital signs and a pale skin. Her BMI was 18Kg/m² but without clinical signs of nutrient deficiency. Abdominal examination revealed a palpable large, mobile, non-tender and ill-defined solid mass in the epigastric and periumbilical region. The laboratory tests showed hypochromic microcystic anemia with a hemoglobin level of 7.7g/dl and a mean corpuscular volume of 64 fl. Renal and hepatic functions were within the reference range.