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Intra-operative enteroscopy in the management of bleeding small bowel lesions
1Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia.
Abstract:
This paper reviews the use of intra-operative enteroscopy at St Vincent's Hospital, Melbourne between 1982 and 1990 in the management of presumed small bowel bleeding. Intra-operative enteroscopy was found to be a moderately technically demanding procedure. The diagnostic yield in this small series of nine patients was 100%. When solitary small bowel lesions are identified, resultant directed therapy should prevent further bleeding. When multiple widespread angiodysplastic lesions are identified as occurred in three cases, the bleeding is difficult to cure.
Insights
Intra-operative enteroscopy offers a 100% diagnostic yield for small bowel bleeding. While effective for single lesions, widespread angiodysplasia presents challenges in achieving a complete cure.
Area of Science:
- Gastroenterology
- Surgical Endoscopy
Background:
- Small bowel bleeding presents diagnostic and therapeutic challenges.
- Intra-operative enteroscopy (IOE) is an endoscopic technique used during surgery.
Purpose of the Study:
- To review the utility of IOE in managing presumed small bowel bleeding.
- To assess the diagnostic yield and therapeutic implications of IOE.
Main Methods:
- Retrospective review of nine patients undergoing IOE for small bowel bleeding.
- Analysis of diagnostic findings and subsequent management.
Main Results:
- IOE demonstrated a 100% diagnostic yield in identifying the source of bleeding.
- The procedure was technically moderately demanding.
- Successful treatment was achieved for solitary lesions.
- Bleeding from multiple, widespread angiodysplastic lesions proved difficult to manage.
Conclusions:
- IOE is a highly effective diagnostic tool for small bowel bleeding.
- Management success depends on the nature and distribution of the identified lesions.
- Further strategies may be needed for diffuse small bowel vascular malformations.