Localization of bleeding site in the small bowel using a combined diagnostic approach

The difficulty in localizing a bleeding site in the small bowel with sufficient accuracy to define a therapeutic target is well known. Great strides have been made in the realms of angiography and endoscopy in finding and treating lesions above the Ligament of Treitz and below the ileocecal valve. Although not as common as these, lesions in the small bowel, frequently remain obscure as to their origin and are associated with significant morbidity and mortality. In a significant percentage of cases, a discreet lesion is not found. Angiography, endoscopy, fluoroscopy and surgical resection have each proved useful but used together can increase the yield in diagnosis and treatment. An approach utilizing all of the above techniques together, necessitated by the failure of endoscopic coagulation and angiographic embolization, will be presented, whereby the bleeding site due to angiodysplasia of the jejunum was identified and definitively resected surgically.