scholarly journals Impacted bone fragment in a small-bowel diverticulum: an extremely rare cause of obscure gastrointestinal bleeding

Endoscopy ◽  
2014 ◽  
Vol 46 (S 01) ◽  
pp. E262-E262
Author(s):  
Hazem Hammad ◽  
Leen Al-Sayyed ◽  
Shoba Theivanayagam ◽  
Van Nguyen ◽  
Arthur Rawlings ◽  
...  
Keyword(s):  
Small Bowel ◽  
Gastrointestinal Bleeding ◽  
Obscure Gastrointestinal Bleeding ◽  
Bone Fragment

scholarly journals Obscure Gastrointestinal Bleeding Caused by Small Bowel Lipoma

2008 ◽  
Vol 47 (18) ◽  
pp. 1601-1603 ◽  
Author(s):  
Jen-Wei Chou ◽  
Chun-Lung Feng ◽  
Hsueh-Chou Lai ◽  
Chin-Chi Tsai ◽  
Sheng-Hung Chen ◽  
...  
Keyword(s):  
Small Bowel ◽  
Gastrointestinal Bleeding ◽  
Obscure Gastrointestinal Bleeding

scholarly journals Massive obscure GI bleeding from Idiopathic Jejunal varices identified using single balloon enteroscopy

2019 ◽  
Vol 16 (1) ◽  
pp. 62-71
Author(s):  
Natasha Harris ◽  
Alaa Rostom ◽  
Husein Moloo
Keyword(s):  
Small Bowel ◽  
Literature Review ◽  
Gastrointestinal Bleeding ◽  
Surgical Resection ◽  
Obscure Gastrointestinal Bleeding ◽  
Gi Bleeding ◽  
Jejunal Varices ◽  
Single Balloon ◽  
Single Balloon Enteroscopy ◽  
Small Bowel Varices

Background:  Obscure gastrointestinal bleeding from idiopathic small bowel varices is both a diagnostic and management challenge for physicians. There are very few cases reported in the literature and there is no consensus on management recommendations. Aims:  To present the case of a 34-year-old male patient with bleeding from idiopathic jejunal varices and to review similar cases in the literature.  Methods:  A case of idiopathic jejunal varices is reported. A literature review was conducted and a total of 24 articles describing idiopathic small bowel varices were identified. Results:  Case Report: A 34-year-old gentleman was referred for worsening obscure gastrointestinal bleeding and anemia. Anterograde single balloon enteroscopy revealed several petechial like lesions that were not classic for angiodysplasia. These lesions were initially treated with argon plasma coagulation and clipped, which did not resolve the patient’s persistent anemia. No venous abnormalities were identified on computed tomography of the abdomen and pelvis with contrast. The patient underwent an endoscopically assisted exploratory laparoscopy that was converted to a laparotomy upon finding of grossly abnormal distal jejunum. Dilated and tortuous varicosities were identified involving approximately 150 cm of small bowel. It was decided to resect the 40 cm segment of jejunum in which varices were visible endoscopically. There was no evidence of thrombosis in the resected specimen. The patient suffered a pulmonary embolism post-operatively, believed to be provoked by the surgery.  The patient has had no re-bleeding 12 months post-resection. Literature Review: Both familial and non-familial accounts of small bowel varices in the absence of a primary cause have been reported in the literature. When supportive therapy is insufficient, the most common treatment modality chosen is surgical resection. Select cases have also demonstrated that sclerotherapy and varix dissection can be used for to treat these lesions. Conclusions:  Idiopathic small bowel varices pose both diagnostic and therapeutic challenges for physicians. In the literature, several treatment modalities have been shown to be successful; these include surgical resection, varix dissection and sclerotherapy. There is no consensus on the preferred treatment strategy. This report demonstrates endoscopically assisted surgical resection as a viable management strategy for bleeding of idiopathic small bowel varices, an uncommon cause of occult GI bleeding.

scholarly journals The Diagnostic Yields and Safety of Double-Balloon Enteroscopy in Obscure Gastrointestinal Bleeding and Incomplete Small Bowel Obstruction: Comparison between the Adults and Elderly

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Lei Wang ◽  
Mengfan Xie ◽  
Liwen Hong ◽  
Chen Zhang ◽  
Tianyu Zhang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Small Bowel ◽  
Gastrointestinal Bleeding ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
The Elderly ◽  
Obscure Gastrointestinal Bleeding ◽  
Double Balloon Enteroscopy ◽  
Balloon Enteroscopy ◽  
Double Balloon

Background. Double-balloon enteroscopy (DBE) is widely used worldwide. However, comparisons between the diagnostic yields in adults and the elderly remain scarce. Aim. The aim of this study is to compare the diagnostic yields and safety of DBE between adults and elderly with obscure gastrointestinal bleeding and incomplete small bowel obstruction. Method. We retrospectively reviewed patients who underwent DBE with indication of obscure gastrointestinal bleeding or incomplete small bowel obstruction in Ruijin Hospital and classified them into adults (18–64 years old) and elderly (≥65 years old). Clinical characteristics, diagnostic yields, and postoperative complications were collected and further analyzed. Results. A total of 877 DBE procedures, 729 in adults and 148 in the elderly, were performed. In the patients with OGIB, the adults showed a higher frequency of Meckel’s diverticulum compared with the elderly (4.6% vs. 0.9%, P=0.032). Angioectasia was higher in frequency in the elderly than in the adults (25.9% vs. 17.9%, P=0.048). In patients with incomplete small bowel obstruction, the elderly were more likely to have adenocarcinoma than the adults (19.4% vs. 7.1%, P=0.038). The adults had higher tendency to have Crohn’s disease than the elderly (23.4% vs. 8.3%, P=0.045). Most of the postoperative complications were mild. The adults and elderly displayed comparable tolerance to DBE (P>0.05) Conclusion. DBE has a high diagnostic yield in small bowel disorders, and a slight difference in disease spectrum was observed between the adults and elderly. DBE can be well-tolerated in the elderly.

scholarly journals New Evidence on the Impact of Antithrombotics in Patients Submitted to Small Bowel Capsule Endoscopy for the Evaluation of Obscure Gastrointestinal Bleeding

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Pedro Boal Carvalho ◽  
Bruno Rosa ◽  
Maria João Moreira ◽  
José Cotter
Keyword(s):  
Small Bowel ◽  
Drug Use ◽  
Gastrointestinal Bleeding ◽  
Capsule Endoscopy ◽  
Diagnostic Yield ◽  
Decisive Role ◽  
Bleeding Risk ◽  
Obscure Gastrointestinal Bleeding ◽  
Anticoagulant Drug ◽  
The Impact

Objectives.Small bowel capsule endoscopy (SBCE) plays a decisive role in the obscure gastrointestinal bleeding (OGIB) diagnosis. Antithrombotics may increase bleeding risk in patients with preexistent lesions or through direct mucosal aggression. We aimed to correlate antithrombotics usage with lesions with bleeding potential found in SBCE.Methods.Retrospective single-center study including 274 consecutive SBCE performed over 7 years for OGIB. The lesions were classified as P0 (no bleeding potential), P1 (uncertain bleeding potential: erosions), and P2 (high bleeding potential: angioectasias, ulcers, and tumors). We assessed antiplatelet and anticoagulant drug use during the 60 days preceding SBCE.Results.One-third of the patients were under antithrombotic therapy. The diagnostic yield of SBCE for P2 lesions was 30.0%. Angioectasias (20.4%) were the most frequently observed lesions. There was a significant correlation between anticoagulant drug use and a higher incidence of P2 lesions in the small bowel (43.2% versus 26.5%; OR = 2.11,P=0.026). We found no significant correlation between antiplatelets and lesions with bleeding potential in SBCE.Conclusions.Small bowel lesions with high bleeding potential were more frequently detected when the patient was on anticoagulant drugs, resulting in a twofold risk. Antiplatelet drugs were not associated with small bowel lesions.

scholarly journals Complimentary Imaging Modalities for Investigating Obscure Gastrointestinal Bleeding: Capsule Endoscopy, Double-Balloon Enteroscopy, and Computed Tomographic Enterography

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Ye Chu ◽  
Sheng Wu ◽  
Yuting Qian ◽  
Qi Wang ◽  
Juanjuan Li ◽  
...  
Keyword(s):  
Small Bowel ◽  
Gastrointestinal Bleeding ◽  
Capsule Endoscopy ◽  
Diagnostic Yield ◽  
Obscure Gastrointestinal Bleeding ◽  
Double Balloon Enteroscopy ◽  
Balloon Enteroscopy ◽  
Computed Tomographic ◽  
Double Balloon ◽  
Complementary Value

Objectives. The complimentary value of computed tomographic enterography (CTE) and double-balloon enteroscopy (DBE) combined with capsule endoscopy (CE) was evaluated in the diagnosis of obscure gastrointestinal bleeding (OGIB).Methods. Patients who received CE examinations at Ruijin Hospital between July 2007 and July 2014 with the indication of OGIB were identified, and those who also underwent DBE and/or CTE were included. Their clinical information was retrieved, and results from each test were compared with findings from the other two examinations.Results. The overall diagnostic yield of CE was comparable with DBE (73.9% versus 60.9%) but was significantly higher than the yield of CTE (87% versus 25%,p<0.001). The diagnostic yield of angiodysplasia at CE was significantly higher than CTE (73% versus 8%,p<0.001) and DBE (39.1% versus 17.4%,p=0.013), while no significant difference was found between the three approaches for small bowel tumors. DBE and CTE identified small bowel diseases undetected or undetermined by CE. Conversely, CE improved diagnosis in the cases with negative CTE and DBE, and findings at initial CE directed further diagnosis made by DBE.Conclusions. Combination of the three diagnostic platforms provides complementary value in the diagnosis of OGIB.

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