A rare case of bleeding jejunal ulcer diagnosed by intraoperative use of enteroscopy

Mikru, Filagot; Gucho, Ayenew; Muleta, Jiksa; Tilahun, Ermias; Haile, Kalkidan; Belayneh, Eden

doi:10.1016/j.ijscr.2024.109250

Cited by 1 publication

(1 citation statement)

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“…In our case, we outline a treatment option for small bowel bleeding due to BRBNS that permits endoscopic therapy with guidance through a mini-laparotomy incision. There have been a few documented cases where intraoperative enteroscopy has been attempted for small bowel gastrointestinal bleeding [9][10][11]. Overall, intraoperative enteroscopy is claimed to be 90% effective at diagnosing small bowel gastrointestinal bleeding [12].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Enteroscopy: A Rare Case of Blue Rubber Bleb Nevus Syndrome and a Rare Complication of Cyanoacrylate Glue

Lekamalage,

Duncan-Were,

Llewelyn

et al. 2024

Cureus

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Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by venous malformations predominantly affecting the skin and gastrointestinal tract, commonly the small bowel. Small bowel gastrointestinal bleeding is often the presenting complaint and is difficult to diagnose and treat. Push enteroscopy, capsule endoscopy, and intraoperative enteroscopy are techniques described for the localization and management of small bowel bleeding. We present the case of a 68-year-old male with BRBNS who presented with symptomatic anemia and melena. Initial endoscopic evaluations identified intraluminal vascular blebs, which were injected; however, bleeding continued, prompting intraoperative enteroscopy. During the procedure, multiple small bowel vascular malformations consistent with BRBNS were identified. Cyanoacrylate glue was used endoscopically to treat active bleeding sites. The patient developed a rare postoperative complication of small bowel ischemia and obstruction secondary to cyanoacrylate glue, necessitating surgical resection. Small bowel bleeding in BRBNS poses diagnostic and therapeutic challenges. Intraoperative enteroscopy together with cyanoacrylate glue offers a valuable approach to localization and intervention. While cyanoacrylate glue is generally considered safe, rare complications, including ischemic events, have been reported. This case highlights the utility of intraoperative enteroscopy and endoscopic cyanoacrylate glue in managing small bowel bleeding associated with BRBNS. While effective, clinicians must be vigilant regarding potential complications, including ischemic events, associated with endoscopic hemostatic agents.

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