Rare case of small intestine bleeding

We present a case of a healthy 59-year-old woman who presented for a capsule endoscopy to evaluate melaena and iron deficiency anaemia. She had previously underwent an oesophagogastroduodenoscopy and colonoscopy at an outside institution which were unremarkable. Capsule endoscopy showed an ulcerated, bleeding lesion likely in the duodenum. Differential diagnosis included adenocarcinoma, carcinoid tumour, lymphoma, gastrointestinal stromal tumour and metastatic disease. A push enteroscopy was performed after which showed an ulcerated mass in the third portion of the duodenum. Biopsies confirmed adenocarcinoma. Computed tomography of the abdomen showed no signs of distant metastasis and the patient was referred to surgery for evaluation. The patient underwent a pancreaticoduodenectomy, with resection of the mass and negative lymph nodes in all nine that were removed (T3N0). The patient was classified as stage II duodenal adenocarcinoma. Duodenal adenocarcinoma is a rare but clinically significant cause of small bowel bleeding.

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Analysis of Non-Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Potential Small Bowel Bleeding

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2016/9063293 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Fatma Ebru Akin ◽

Oyku Tayfur Yurekli ◽

Aylin Demirezer Bolat ◽

Mustafa Tahtacı ◽

Huseyin Koseoglu ◽

...

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Video Capsule Endoscopy ◽

Gi Bleeding ◽

Gastric Lesions ◽

Male Ratio ◽

Bleeding Lesion ◽

Anastomotic Bleeding ◽

Bowel Segments ◽

Small Bowel Bleeding

Gastrointestinal (GI) bleeding cases in whom source cannot be identified after conventional upper and lower GI endoscopy are defined as potential small bowel bleeding. We aimed to search for lesions in the reach of conventional endoscopy in patients to whom video capsule endoscopy (VCE) had been applied for potential small bowel bleeding. 114 patients who had VCE evaluation for potential small bowel bleeding between January 2009 and August 2015 were retrospectively evaluated. Mean age of the patients was 55 ± 17 years. Female/male ratio is 39/75. In 58 patients (50.9%) bleeding lesion could be determined. Among these 58 patients 8 patients’ lesions were in the reach of conventional endoscopes. Overall these 8 patients comprised 7% of patients in whom VCE was performed for potential small bowel bleeding. Among these 8 patients 5 had colonic lesions (4 angiodysplasia, 1 ulcerated polypoid cecal lesion), 2 had gastric lesions (1 GAVE, 1 anastomotic bleeding), and 1 patient had a bleeding lesion in the duodenal bulbus. Although capsule endoscopy is usually performed for potential small bowel bleeding gastroenterologists should always keep in mind that these patients may be suffering from bleeding from non-small bowel segments and should carefully review images captured from non-small bowel areas.

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Rendimiento diagnóstico de la videocápsula endoscópica en el sangrado del intestino delgado manifiesto

Acta gastroenterológica latinoamericana ◽

10.52787/dzvw9801 ◽

2020 ◽

Vol 50 (4) ◽

Author(s):

María Alejandra Arriola ◽

Diana Valencia ◽

Carolina Olano

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Laboratory Data ◽

Increased Risk ◽

Frequent Finding ◽

Male Sex ◽

Lower Endoscopy ◽

Small Bowel Bleeding ◽

Nonspecific Inflammation

Introduction. The small bowel capsule endoscopy is the first line procedure in patients with suspected small bowel bleeding. Data regarding overt suspected small bowel bleeding and its predictive factors remain still limited. Aim. To assess the diagnostic yield of the capsule endoscopy and the factors predicting positive findings in patients with overt suspected small bowel bleeding. Methods. Patients with overt suspected small bowel bleeding (melena or enterorrhagia) and negative upper and lower endoscopy were included. A positive diagnostic yield was considered when the capsule endoscopy diagnosed one or more P2 or P3 type lesions (Modified Saurin Classification) Demographic and laboratory data were recorded. Results. 79 patients were included (mean age 62.92 (15-89); F:M 46:33). The diagnostic yield of the capsule endoscopy was 62%. The most frequent finding was angioectasia (44.8%), followed by nonspecific inflammation/ulceration (20.4%). The multivariate analysis found that age older than 50 years and male sex were independent variables that were associated with an increased risk of positive findings and angioectasia. Conclusions. In this group of patients with overt suspected small bowel bleeding, the capsule endoscopy was useful (with a diagnostic yield of 62%). The most frequent lesions were the vascular ones. Age over 50 and male sex were independent predictors of finding lesions and angioectasia.

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630 Inpatient Capsule Endoscopy Does Not Lead to Increased Hospital Interventions in Stable Small Bowel Bleeding

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000592056.63353.30 ◽

2019 ◽

Vol 114 (1) ◽

pp. S367-S367

Author(s):

Henry Jen ◽

Leona Al Sayah ◽

Daniel Sosa ◽

Erin Taub ◽

Farah Monzur

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Small Bowel Bleeding

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Su1192 Predictors of Active Small Bowel Bleeding Warrant Early Capsule Endoscopy

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.708 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB309

Author(s):

Sara Monteiro ◽

Pedro Boal Carvalho ◽

Tiago Cúrdia Gonçalves ◽

Maria João Moreira ◽

Bruno Rosa ◽

...

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Small Bowel Bleeding

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Aortoenteric fistula: a rare but critical cause of small bowel bleeding discovered on capsule endoscopy

BMJ Case Reports ◽

10.1136/bcr-2019-230083 ◽

2019 ◽

Vol 12 (5) ◽

pp. e230083

Author(s):

Matt Davie ◽

Diana E Yung ◽

John N Plevris ◽

Anastasios Koulaouzidis

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Abdominal Aortic Aneurysm Repair ◽

Sudden Onset ◽

Aortoenteric Fistula ◽

Good Effect ◽

Stent Grafting ◽

Abdominal Aortic ◽

History Of ◽

Small Bowel Bleeding

A 78-year-old man attended for outpatient capsule endoscopy, to investigate a recent history of unexplained small bowel bleeding. His previous medical history included an abdominal aortic aneurysm repair 6 years ago. Soon after capsule ingestion, he experienced sudden onset abdominal pain and collapsed on hospital grounds. He was rapidly transferred to the emergency department as he was haemodynamically unstable, and a significant per rectum (PR) bleed was found on examination. The patient was quickly stabilised following fluid resuscitation. CT angiography was performed which did not show active bleeding. However, use of the real-time capsule viewer indicated a profuse active jejunal bleed originating from the aortic graft, suggestive of an aortoenteric fistula. The patient underwent emergency endovascular cuff placement, and subsequent endovascular abdominal aortic stent grafting, to good effect.

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The Diagnostic Value of Push-Enteroscopy, Capsule Endoscopy, Ileoscopy and Enteroclysis (Sellink) for Small Bowel Evaluation in Patients with Familial Adenomatous Polyposis (FAP): A Comparative Prospective Trial

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2006.03.397 ◽

2006 ◽

Vol 63 (5) ◽

pp. AB180

Author(s):

Nicola Plum ◽

Andrea May ◽

Christian Ell

Keyword(s):

Small Bowel ◽

Familial Adenomatous Polyposis ◽

Capsule Endoscopy ◽

Prospective Trial ◽

Diagnostic Value ◽

Adenomatous Polyposis ◽

Push Enteroscopy

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Capsule endoscopy: Is the software TOP 100 a reliable tool in suspected small bowel bleeding?

Digestive and Liver Disease ◽

10.1016/j.dld.2019.06.008 ◽

2019 ◽

Vol 51 (12) ◽

pp. 1661-1664 ◽

Cited By ~ 3

Author(s):

Cátia Arieira ◽

Sara Monteiro ◽

Francisca Dias de Castro ◽

Pedro Boal Carvalho ◽

Bruno Rosa ◽

...

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Reliable Tool ◽

Small Bowel Bleeding

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P169 Balloon enteroscopy in small bowel Crohn’s disease (CD) with suspected bleeding

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.298 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S222-S222

Author(s):

N M LAW

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Therapeutic Intervention ◽

Definitive Diagnosis ◽

Gi Bleeding ◽

Ileal Stricture ◽

Single Operator ◽

Small Bowel Bleeding

Abstract Background Deep enteroscopy with Single Balloon Enteroscopy (SBE) has been used in the evaluation of small bowel diseases and could be performed by a single operator. The role and safety of SBE in suspected small bowel CD with bleeding remained uncertain. Our primary aim was to evaluate the role of SBE in the management of suspected small bowel Crohn’s Disease (CD) with bleeding. The secondary aim was to find out whether SBE could provide definitive diagnosis and therapeutic intervention. Methods Hospitalised patients with iron deficiency anaemia (IDA) and/or overt GI bleeding were studied. All had prior negative oesophagogastro-duodenoscopy (OGD) and colonoscopy followed by single operator SBE. The indications were IDA in 28 patients, overt GI bleeding in 18 patients and IDA with abdominal pain and/or weight loss in 6 patients. Twenty and six patients had CT scan and capsule endoscopy done respectively with normal or unconfirmed small bowel lesions. Results Fifty-two patients with suspected small bowel bleeding were studied with mean age of 51 (range 20 -84) years. Small bowel Crohn’s disease were diagnosed in 7 patients with jejunal and ileal involvement in 2 and 5 patients respectively. All patients had subsequent histopathology confirmation from biopsies taken during the procedures. In addition, SBE allowed the retrieval of a stuck capsule scope in a patient with proximal ileal stricture. Repeated balloon dilatation through SBE was done successfully in one patient with distal ileal stricture without complication. Conclusion Small bowel Crohn’s disease was found in 21% of our patients with suspected small bowel bleeding. SBE is the preferred method of small bowel evaluation after negative upper and lower GI evaluation in this selected patients. Definitive diagnosis and targeted biopsies confirmed the diagnosis of CD as compared with radiological imaging and capsule endoscopy. SBE also provided safe therapeutic intervention in those patients with small bowel stricture from CD through endoscopic dilatation.

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