While rooting around during an oesophagogastroduodenoscopy for a piece of impacted pork in their patient’s oesophagus, doctors happened upon a different, much more unusual, sort of pigmentation in his duodenum.

The 83-year-old presented to a hospital in Newcastle, NSW, with the oesophageal obstruction and intermittent dysphagia lasting several months.

He had a history of stage 4 chronic kidney disease, hypertension and type 2 diabetes. His antihypertensive medications included hydralazine, irbesartan, lercanidipine and metoprolol but no iron supplementation.

The urgent gastroscopy successfully retrieved the impacted food but the Aussie doctors then spotted a rare sight: the elderly man’s duodenal mucosa was laden with dark speckles, extending all along the villi.