Evaluation & Management of Obscure Gastrointestinal Bleeding (OGIB)

Gastrointestinal bleeding is a common entity. Incidence of bleeding has comparatively increased though case fatality is static. Despite improved treatments and better understanding of the underlying pathophysiology of peptic ulcer disease the rising figures of GI bleeding reflect an increasing proportion of elderly population and nonsteroidal anti-inflammatory use. Overall, 5% of all cases of gastrointestinal bleeding fall under the category of Obscure gastrointestinal bleeding (OGIB) in the USA. Obscure gastrointestinal bleeding is defined as bleeding of unknown origin that persists or recurs after an initial negative endoscopic evaluation including colonoscopy and/or upper endoscopy. OGIB can be either Occult (no visible blood) or Overt (Passage of visible blood).Less common aetiologies of GI bleeding e.g. Cameron erosions, Dieulafoy’s lesion, Watermelon stomach that are sometimes difficult to identify at endoscopy often present as OGIB. They need special techniques even thrombolytic therapy to precipitate bleeding for diagnostic angiography. Increased awareness of the existence of such conditions help in rapid and accurate identification of the lesion. Review of such cases will be the focus of this publication. DOI: 10.3329/jbcps.v28i3.6512J Bangladesh Coll Phys Surg 2010; 28: 174-182

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

McMaster University Medical Journal ◽

10.15173/mumj.v16i1.2025 ◽

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.

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Upper gastro-intestinal bleeding: Aetiology and demographic profile based on endoscopic examination at Dhulikhel Hospital, Kathmandu University Hospital

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i2.3560 ◽

1970 ◽

Vol 8 (2) ◽

pp. 208-211 ◽

Cited By ~ 3

Author(s):

RB Gurung ◽

G Joshi ◽

N Gautam ◽

P Pant ◽

B Pokhrel ◽

...

Keyword(s):

Peptic Ulcer ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Examination ◽

Oesophageal Varices ◽

Gi Bleeding ◽

Ulcer Disease ◽

Upper Gi Bleeding ◽

Upper Gi ◽

Upper Gastrointestinal

Background: The upper gastrointestinal bleeding (UGIB) is defined as bleeding within the intraluminal gastrointestinal tract from any location between the upper oesophagus to the duodenum at the ligament of Treitz. It is one of the important medical emergencies worldwide. Objective: The objective of this study is to study the aetiology of upper gastrointestinal bleeding based on endoscopic examination findings in patients of various demographic characteristics. Materials and methods: This is a retrospective observational study. The endoscopic record book from 2007 January to 2009 October was reviewed for all the cases who underwent oesophago-gastro-duodenoscopic examination for upper GI bleeding. The clinico-epidemiological data of all the patients was reviewed and analyzed in concert with the aetiology of bleeding. Results: A total of 90 patients (58 males, 32 females; mean age 45.32+ 18.47 years) of upper gastrointestinal bleeding was studied and analyzed in terms of aetiology of bleeding and demographic profile. Among the ethnic groups, Aryan 46 (51%) was the most common ethnic group to have upper GI bleeding followed by Newars 24 (27%), Mongolians 16 (18%), Dalits 3 (3%) and others 1 (1%). Out of 90 patients, 47( 52.2%) cases was less than 45 years of age, 30(33.3%) of 46 to 65 age ; and 13(14.4 %) more than 65 years of age. Gastric ulcer 23(25.6%) was the most common endoscopic finding, followed by oesophageal varices 14 (15.6%), acute erosive/haemorrhagic gastropathy 11 (12.2%), duodenal ulcer 9(10%), growth 7(7.8%), vascular lesions 3(3.3%), Mallory-Weiss tear 1(1.1%), fundal varices 1(1.1%) and, no cause was identified in 21(23.3%) cases. The peptic ulcer bleeding was the most common finding in Aryan 22(47.9%), whereas oesophageal varices and growth were more common in Newar 7(29.2%) and 3 (12.5%) respectively. Conclusion: Peptic ulcer disease is the most common cause of upper GI bleeding which was most commonly found in Aryan population; followed by oesophageal varices and growth as second and third most common causes and were more prevalent in Newar and Mongolian people. Key words: Endoscopy; Peptic ulcer disease; Upper GI bleeding; Varices DOI: 10.3126/kumj.v8i2.3560 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 208-211

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