Mittlere gastrointestinale Blutung bei neuroendokrinen Tumoren

Zusammenfassung

In der folgenden Kasuistik wird der Fall eines 44-jährigen Patienten beschrieben, der mit Hb-relevantem peranalem Blutabgang stationär aufgenommen wurde. Bei fehlendem Hinweis für eine Blutungsquelle in der Ösophagogastroskopie und Ileokoloskopie erfolgte bei fortbestehendem transfusionspflichtigem peranalem Blutabgang und Kreislaufinstabilität eine intraoperative Enteroskopie. Hierbei waren im Jejunum 4 kleine polypöse Prozesse sichtbar, die histologisch einem neuroendokrinen Tumor entsprachen.

Abstract

In the following report the case of a 44 year old patient is described who was having in-patient treatment due to peranal Hb relevant bleeding. The cause of bleeding not being determined either by oesophagogastroscopy or by ileoscopy, blood transfusion was essential due to peranal bleeding and circulation instability and an intraoperative enteroscopy was initiated during which polypial structures were found which are the equivalent of a neuroendocrine tumor.

Schlüsselwörter

mittlere gastrointestinale Blutung - neuroendokriner Tumor Dünndarm

Key words

small bowel bleeding - neuroendocrine tumors of the small bowel

• Literatur

• 1 Hatzaras I et al. Small-bowel tumors: epidemiologic and clinical characteristics of 1260 cases from the Conneticut tumor registry. Archives of Surgery 2007; 142: 229-235
• 2 Modlin I et al. A three-decade analysis for 3911 small intestinal neuroendocrine tumors: the rapid pace of no progress. American Journal of Gastroenterol 2007; 102: 1464-1473
• 3 Ellis L et al. Carcinoid tumors of the gastrointestinal tract: trends in incidence in England since 1971. Am J Gastroenterol 2010; 105: 2563-2569
• 4 Yao JC et al. One hundred years after carcinoid: epidemiology of and prognostic factors for neuroendocrine tumors in 35.825 cases in the United States. J Clin Oncol 2008; 26: 3063-3072
• 5 Berge T et al. Carcinoid tumours. Frequency in a defined population during a 12-year period. Acta Pathol Microbiol Scand 1976; 84: 322-330
• 6 Ito T et al. Epidemiological study of gastroenteropancreatic neuroendocrine tumors in Japan. J Gastroenterol 2010; 45: 234-243
• 7 Öberg K et al. Neuroendocrine gastro-entero-pancreatic tumors: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of oncology 2012; 23 (Supp. 7): vii 124 – vii 130
• 8 Ell C et al. Mid-gastrointestinal bleeding: capsule endoscopy and push-and-pull enteroscopy give rise to a new medical term. Endoscopy 2006 38: 73-75
• 9 Jakobs R. Diagnosis of obscure gastrointestinal bleeding by intraoperative enteroscopy in 81 consecutive patients. Gastroenterol 2006; 12: 313-316
• 10 Greve E et al. High diagnostic and clinical impact of small bowel capsule endoscopy in patients with hereditary hemorrhagic teleangiectasia with overt digestive bleeding and/or severe anaemia. Gastrointest. Endosc 2010; 71: 760-767
• 11 Reiter S et al. Capsule endoscopy of ther upper gastrointestinaltract – the need for a second endoscopy. Digestion 2005; 72: 242-247
• 12 May A et al. Kapselendoskopie in der Diagnostik von Dünndarmerkrankungen. Gastroenterol 2010; 48: 1384-1404
• 13 Pennazio M et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology 2004; 126: 643-653
• 14 Esaki M et al. Factors associated with clinical impact of capsule endoscopy in patients with overt obscure gastrointestinal bleeding. Dig Dis Sci 2009; 55: 2294-2301
• 15 May A et al. Influence of patient selection on the outcome of capsule endoscopy in patients with chronic gastrointestinal bleeding. J Clin Gastroenterol 2005; 39: 684-688
• 16 Apostolopoulos P et al. Evaluation of capsule endoscopy in active, mild-to-moderate, overt, obscure GI bleeding. Gastrointest Endosc 2007; 66: 1174-1181
• 17 Hartmann D et al. A prospective two-center study comparing wireless capsule endoscopy with intraoperative enteroscopy in patients with obscure GI bleeding. Gastrointest Endosc 2005; 61: 826-832
• 18 Hadithi M et al. A prospective study comparing video capsule endoscopy with double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2006; 101: 52
• 19 Nakamura M et al. Preliminary comparison of capsule endoscopy and double-balloon enteroscopy in patients with small-bowel bleeding. Endoscopy 2006; 38: 59-66
• 20 Marmo R et al. Degree of concordance between double-ballon enteroscopy and capsule endoscopy in obscure gastrointestinal bleeding: a multicenter study. Endoscopy 2009; 41: 587-592
• 21 Patel N et al. Changes in efficiency and resource utilization after increasing experience with double balloon enteroscopy. World J Gastrointest Endosc 2013; 5: 89-94
• 22 Kameda N et al. A prospective, single-blind trial comparing wireless capsule endoscopy and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. J Gastroenterol 2008; 43: 434-440
• 23 Hadithi M et al. A prospective study comparing video capsule endoscopy with double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. Am J Gastroenterolog 2006; 101: 52
• 24 Kamalaporn P et al. Double-ballon enteroscopy following capsule endoscopy in the management of obscure gastrointestinal bleeding: outcome of acombined approach. Can J Gastroenterol 2008; 22: 491-495
• 25 Hartmann D et al. A prospective two-center study comparing wireless capsule endoscopy with intraoperative enteroscopy in patients with obscure GI bleeding. Gastrointest Endosc 2005; 61: 826-832
• 26 Monsanto P et al. Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?. Rev Esp Enferm Dig 2012; 104: 190-196
• 27 Saperas E et al. Capsule endoscopy versus computed tomographic or standard angiography for the diagnosis of obscure gastrointestinal bleeding. Am J Gastroenterol 2007; 102: 731-737
• 28 Agrawal JR et al. Diagnostic yield of dual-phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non-diagnostic capsule endoscopy. J Gastroenterol Hepatol 2012; 27: 751-759