Intra-Operative Enteroscopy: A Last Resort in Small Bowel Bleeding

Aims Only 5 % of gastrointestinal (GI) bleeding occur in the small bowel (SB) but it accounts for most obscure GI bleeding. The availability of new diagnostic tools like computed tomography enterography (CTE), capsule endoscopy (CE) and double balloon enteroscopy has led to a paradigm shift in SB bleeding management. We, herein, present a case in which the non-surgical approach was not feasible.

Methods

Results Case Report: A 60-year-old male patient was admitted in the gastroenterology department for melena and acute blood loss. He had started dual antiplatelet therapy after coronary angioplasty the previous week. In the initial admission the patient was unstable and was admitted in the gastroenterology intensive care unit for surveillance. He underwent gastroscopy and colonoscopy without relevant alterations. CE showed active jejunal bleeding, but its etiology was not defined by this technique. An oral balloon assisted enteroscopy identified small hemorrhagic suffusions that were fulgurated but the patient presented recurrent melena. The following month, an emergency push enteroscopy due to hemorrhagic shock was performed and did not shown any lesions. CTE and CT angiography were normal. Meckel scintigraphy did not show ectopic gastric mucosa. As GI bleeding persisted, he underwent repeated CE showing an erosion with a central vascular prominence and an intra-operative enteroscopy through the enterotomy site was performed. A small ulcer with a reddish center, similar with the lesion in the CE, was identified and a jejunal segmental enterectomy was performed. Histology revealed fibrosis and submucosal congestion. The patient required a total of 26 red blood cell transfusions in 4 months. GI bleed did not recur following the procedure and the patient sustains a stable hemoglobin 10 months later.

Conclusions Intra-operative enteroscopy maintains its importance in the evaluation of SB bleeding specially when SB lesions have not been localized or successfully treated with other less invasive techniques.

Citation Costa M, Macedo C, Amaro A et al. eP106 INTRA-OPERATIVE ENTEROSCOPY: A LAST RESORT IN SMALL BOWEL BLEEDING. Endoscopy 2021; 53: S131.

Publikationsverlauf

Artikel online veröffentlicht:
19. März 2021