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Jejunoileal causes of overt gastrointestinal bleeding: diagnosis, management, and outcome
W H Schwesinger1, K R Sirinek, H V Gaskill
1Department of Surgery, University of Texas Health Science Center at San Antonio, 78229-7842, USA.
Insights
Small intestinal bleeding is rare but serious, often caused by arteriovenous malformations or tumors. Diagnosis relies on imaging and surgery, with significant morbidity possible.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Diagnostic Imaging
Background:
- Major bleeding from the small intestine is uncommon and challenging to localize.
- Etiologies and diagnostic/therapeutic strategies for small intestinal hemorrhage require examination.
Purpose of the Study:
- To investigate the causes of small intestinal bleeding.
- To assess diagnostic and therapeutic approaches for small intestinal hemorrhage.
Main Methods:
- Retrospective review of adult patients undergoing surgery for small intestinal hemorrhage over a 10-year period (1989-1998).
- Analysis of preoperative diagnostic methods (endoscopy, scintigraphy, angiography, CT scan) and intraoperative findings.
- Evaluation of surgical outcomes, including morbidity and hospitalization duration.
Main Results:
- Twelve patients (8 male, 4 female, mean age 54) were identified.
- Arteriovenous malformations (6 patients) and tumors (3 patients: leiomyoma, leiomyosarcoma, adenocarcinoma) were the most common causes.
- Other causes included Meckel's diverticulum (2 patients) and Crohn's disease (1 patient).
- Preoperative diagnosis utilized endoscopy, scintigraphy, angiography, and CT scan.
- Intraoperative panendoscopy aided localization in 5 cases.
- No operative deaths occurred, but major morbidity was observed in 5 patients (42%), with an average hospitalization of 17 days.
Conclusions:
- Jejunoileal lesions are an infrequent but potentially high-morbidity cause of intestinal bleeding.
- Arteriovenous malformations and tumors are the predominant etiologies.
- Accurate diagnosis and effective management necessitate selective preoperative imaging and careful surgical exploration.
Abstract:
Major bleeding from the small intestine is uncommon and difficult to localize. We examined its etiologies and assessed available diagnostic and therapeutic approaches. The records of all adults undergoing operation for small intestinal hemorrhage over a 10-year period (1/89-12/98) were reviewed. There were eight men and four women with a mean age of 54 years. Six patients presented with arteriovenous malformations. Preoperative diagnosis was by endoscopy (three of six), scintigraphy (two of two), and/or angiography (two of six). Intraoperative panendoscopy was used for localization in 5 cases. Three other patients had tumors (leiomyoma, leiomyosarcoma, and adenocarcinoma) by CT scan (two) and/or scintigraphy (two). All were resected but one patient died of recurrence. Two patients underwent resection of a Meckel's diverticulum, one after angiographic diagnosis. Another patient with Crohn's disease had a positive angiogram and colonoscopy before resection. There were no operative deaths but major morbidity occurred in five patients (42%) and hospitalization averaged 17 days. We conclude that jejunoileal lesions are a rare cause of intestinal bleeding but can be associated with substantial morbidity. Arteriovenous malformations and tumors remain the most common causes. An accurate diagnosis and definitive management depend on selective preoperative imaging and judicious operative exploration.