Small Bowel Bleeding: A Challenging Diagnosis

The small intestine is an uncommon site for acute gastrointestinal (GI) bleeding. However, it is responsible for most cases in which the etiology of bleeding is not identified through endoscopy or colonoscopy. Despite great advances in technology, small bowel bleeding (SBB) is often a challenging diagnosis, requiring multiple blood transfusions, diagnostic procedures, and re-admissions. Consequently, it increases comorbidities, complications, and costs to the health care system. The presentation of SBB is diverse, and the etiology is dependent on the patient's age. It may require aggressive resuscitation and immediate bleeding-site localization for proper and successful care. The management is based on the etiology, the available technology, and physician expertise. We present a case of SBB in which multiple imaging and endoscopic procedures were required to identify the culprit lesion. Additionally, we review the most common etiologies, radiologic modalities, and endoscopic procedures available.