A practical approach for small bowel bleeding

Abstract

Gastrointestinal (GI) bleeding is one of the most common conditions among patients visiting emergency departments in Korea. GI bleeding is divided into upper and lower GI bleeding, according to the bleeding site. GI bleeding is also divided into overt and occult GI bleeding based on bleeding characteristics. In addition, obscure GI bleeding refers to recurrent or persistent GI bleeding from a source that cannot be identified after esophagogastroduodenoscopy or colonoscopy. The small intestine is the largest part of the alimentary tract. It extends from the pylorus to the cecum. The small intestine is difficult to access owing to its long length. Moreover, it is not fixed to the abdominal cavity. When hemorrhage occurs in the small intestine, the source cannot be found in many cases because of the characteristics of the small intestine. In practice, small-intestinal bleeding accounts for most of the obscure GI bleeding. Therefore, in this review, we introduce and describe systemic approaches and examination methods, including video capsule endoscopy and balloon enteroscopy, that can be performed in patients with suspected small bowel bleeding in clinical practice.

Case 19: A 65-Year-Old Man With Melena and Hematochezia

“…If no abnormalities are found in EGD and colonoscopy, small bowel bleeding needs to be differentiated, and a non-invasive capsule endoscopy is generally recommended as the first step. 3 If the lesion is not identified on capsule endoscopy or enhanced abdomen CT or if there is persistent bleeding, double balloon enteroscopy is recommended. Balloon enteroscopy is an invasive test method, but it has the advantage of being able to observe the entire small bowel and perform direct surgery on the lesion area.…”

Aortoduodenal fistula bleeding caused by an aortic stent graft

“… 2 Therefore, aortoduodenal fistula should be considered a potential cause of hematemesis or hematochezia in patients with a history of aortic stent graft. 3 …”

Jejunal Dieulafoy’s lesion resembling subepithelial mass resulting in profound gastrointestinal hemorrhage

“…The incidence, accounting for approximately 1% to 2%, is relatively uncommon. 1 Approximately 70% of these lesions are located in the proximal stomach, within 6 cm of the esophagogastric junction. Other common locations include the duodenum and esophagus.…”