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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.

The American Surgeon
|April 20, 2001
PubMed

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.

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