Variceal bleeding from ileum identified and treated by single balloon enteroscopy

Area of Science:

• Gastroenterology
• Hepatology
• Endoscopy

Background:

• Liver cirrhosis frequently leads to gastrointestinal bleeding, often from esophageal varices.
• Small bowel varices are a less common but significant cause of obscure gastrointestinal bleeding.

Observation:

• A patient with liver cirrhosis presented with acute, uncontrolled gastrointestinal bleeding.
• Standard upper and lower endoscopic evaluations did not identify the bleeding source.

Findings:

• Single-balloon enteroscopy enabled detailed examination of the small bowel.
• Bleeding varices in the ileum were identified as the source of hemorrhage.
• A freehand injection technique using a sclerosant solution was successfully employed via single-balloon enteroscopy for treatment.

Implications:

• Single-balloon enteroscopy is a valuable tool for diagnosing obscure gastrointestinal bleeding in cirrhosis.
• Freehand sclerosant injection is a feasible treatment for small bowel varices.
• This approach offers a potential therapeutic option for managing refractory gastrointestinal bleeding in liver disease.