Diagnosis and treatment of small intestinal bleeding: Retrospective analysis of 76 cases

Multiple Small Bowel Cavernous Hemangiomatosis: Case Report and Literature Review

A 79 year old female individual presented to the hospital and complained of 1 month melena and anemia due to chronic gastrointestinal bleeding because of cavernous hemangiomatosis of the small bowel. After undergoing an initial video laparoscopic jejunal-ileal resection surgery 7 days after first hospitalization, given the persistence of anemia, she underwent laparotomic duodenojejunal resection surgery again 2 months later. Multiple cavernous hemangiomatosis is a rare vascular disease (7-10% of all benign small bowel tumors), and it often manifests with bleeding, which may be occult or massive; more rarely, it manifests with intestinal occlusion or perforation. Diagnoses often require the use of multiple radiological and endoscopic methods; video capsule endoscopy has significantly increased the diagnostic rate. The gold standard of treatment is surgical resection, whenever possible, balancing the need for radicality with the possible metabolic consequences of massive small intestine resections.

An intelligent intestinal bleeding diagnosis and treatment capsule system based on color recognition

To our best knowledge, there are no non-invasive and painless means for the diagnosis and treatment of intestinal bleeding as of now, especially the segment of intestine that cannot be reached by endoscopy. We proposed an intelligent intestinal bleeding diagnosis and treatment capsule (IBDTC) system for the first time to diagnose and treat intestinal bleeding with low power consumption, estimated to be about 2.16mW. A hue-saturation-light (HSL) color space method was applied to diagnose bleeding according to H (hue) values of the film dyed by blood. A MEMS-based micro-igniter works as the critical component of the micro-thruster that houses the propellant (74.6% potassium nitrate, 11.9% sulfur, 13.5% charcoal) and the detonating agent (dinitrodiazophenol), to help release drug. Bleeding detection and ignition tests were performed to justify its feasibility and reliability. Results demonstrated that the bleeding diagnosis module of the IBDTC can effectively detect bleeding and the micro-igniter can successfully ignite the propellant. Owing to its simplicity and intelligence, the IBDTC system will pave a way for future accurate treatment of small intestinal bleeding with no injury, no pain, no complicated supporting equipment, no need for in vitro operation and positioning.

A rare case of Goodpasture syndrome concomitant with bleeding jejunal Dieulafoy's lesion

An 81-year-old man was diagnosed with Goodpasture syndrome (GS) because he met the criteria of positive anti-GBM antibodies, rapid progressive glomerulonephritis and pulmonary hemorrhage. After starting plasmapheresis and steroid pulse therapy, he experienced tarry stool and contrast-enhanced CT revealed an aneurysmal finding in the jejunum. Paroral enteroscopy showed a jejunal Dieulafoy's lesion (DL) with gush-out hemorrhage. Hemostasis was successfully achieved by hemoclipping, and he then experienced no re-bleeding events. GS can present as a jejunal DL, and contrast-enhanced CT is useful for investigating the etiology and site of small intestinal bleeding, which can lead to smooth, effective endoscopic hemostasis.

Standard Approach to Gastrointestinal Stromal Tumors - Differences between China and Europe

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. With the considerable research and application of molecular-targeted therapy for GISTs in the last two decades, GISTs have become a model of multidisciplinary oncological treatment. Although Western clinical guidelines are available for GISTs, such as those by the European Society of Medical Oncology (ESMO), the clinical situations in China are different from those in European countries. There are distinct differences between the clinical practice, diagnostic methods, surgical approach, and availability of new targeted agents in China and those in Europe. This review summarizes the Chinese GIST consensus guidelines compared to the European ones, which may provide an optimal approach to the diagnosis and management of GIST patients.

Management of hemorrhage in gastrointestinal stromal tumors: a review

Gastrointestinal stromal tumors (GISTs) are relatively common mesenchymal tumors. They originate from the wall of hollow viscera and may be found in any part of the digestive tract. The prognosis of patients with stromal tumors depends on various risk factors, including size, location, presence of mitotic figures, and tumor rupture. Emergency surgery is often required for stromal tumors with hemorrhage. The current literature suggests that stromal tumor hemorrhage indicates poor prognosis. Although the optimal treatment options for hemorrhagic GISTs are based on surgical experience, there remains controversy with regard to optimum postoperative management as well as the classification of malignant potential. This article reviews the biological characteristics, diagnostic features, prognostic factors, treatment, and postoperative management of GISTs with hemorrhage.

Ectopic pancreas bleeding in the jejunum revealed by capsule endoscopy

Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy.

Laparoscopic treatment for small intestinal bleeding: a report of 77 cases

BACKGROUND

Morbidity of small intestinal disease is rare and the associated lesion is hard to be detected due to lack of specific manifestations and effective diagnostic approaches. Hematochezia and melena are the most common symptoms in small intestinal diseases. Hence, small intestinal disease is an important differential diagnosis when hematochezia or melena occurs, especially when gastric and colonic diseases are excluded. As the small intestinal lesion is hard to be located preoperatively, laparotomy used to be performed without a preoperative location. This might lead to related postoperative complications. With the development of laparoscopic technique, laparoscopic operations are more frequently applied to surgical disease, despite their benign or malignant nature. Generally, almost all kinds of small intestinal disease can be treated with laparoscopic surgery.

METHODS

Clinical data of 77 patients with small intestinal bleeding undergoing laparoscopic or laparoscopy-assisted operations from April 2003 to December 2008 were included, and their clinical information were analyzed retrospectively.

RESULTS

No intraoperative complication or conversion was observed in all cases. The mean operative time, mean estimated blood loss, and mean size of incision were 78.3 +/- 30.5 minutes, 17.5 +/- 9.8 mL, and 3.3 +/- 1.9 cm, respectively. Postoperative complications occurred in 4 patients, including 2 cases of adhesive ileus, 1 case of gastric retention, and 1 case of anastomotic bleeding. All of them were cured by nonoperative management. The mean flatus time was 2 days after operation and the mean postoperative hospital stay was 7 days. There was 1 case of gastrointestinal stromal tumor with local recurrence and hepatic metastasis. Four patients died from metastasis of malignant tumors during the follow-up from 2 to 70 months after operations. No trocar site or wound recurrences were noted.

CONCLUSIONS

Laparoscopic treatment in small intestinal bleeding is feasible, safe, and minimally invasive. It may be widely used in the future for its good therapeutic outcomes and improved diagnostic chance in small intestinal bleeding diseases.

[Diagnosis and effective treatment of jejunal polyposis causing massive gastrointestinal bleeding]

The authors present an interesting case of massive gastrointestinal bleeding which is caused by extended jejunal polyposis. They discuss the diagnostic challenges and the way of successful treatment of this case. The authors also summarize their experience and review the relevant literature regarding acute gastrointestinal bleeding from the small bowel.

Adenomyoma of the jejunum --- a rare cause of gastrointestinal bleeding

Adenomyoma of the small intestine is rare. It occurs mostly in the periampullary region or ileum. The common presentations are intussusception and intestinal or biliary obstruction, depending on the location. To our knowledge, gastrointestinal (GI) bleeding from a jejunal adenomyoma has not been reported previously. We present a 74-year-old female patient who suffered intermittent tarry stool passage for 1 month. Initial upper GI endoscopy, colonoscopy and computed tomography failed to find the bleeder. A papilla-like tumor with central depression and active bleeding in the proximal jejunum was found by push enteroscopy. Exploratory laparotomy showed a submucosal nodule about 1.5 cm in size located about 20 cm distal to the Treitz ligament. Wedge resection was carried out. Pathologic examination revealed that the tumor was composed of some cystic exocrine-type ducts and bundles of smooth muscle, indicating adenomyoma. The patient was symptom-free following operation.

Etiology and diagnosis of small intestinal bleeding

The etiology of intestinal bleeding is complicated and its diagnosis is relatively difficult because clinical symptoms and signs commonly obscure alimentary tract bleeding. Present diagnostic methods include enteroscopy, barium and air double contrast X-ray examination, selective angiography, nuclear scintigraphy, and helical computed tomography. Application of double-balloon enteroscopy and wireless capsule endoscopy offers new methods for the diagnosis of small intestinal bleeding. Such patients sometimes still need to undergo laparoscopy or exploration laparotomy even when advanced investigation methods are used. This paper reviews the etiology of small intestinal bleeding and evaluates the advantages and disadvantages of different diagnostic methods to provide clinicians with a reference for etiological analysis and clinical determination of small intestinal bleeding.