Small bowel melaena: 2 cases diagnosed by angiography

Area of Science:

• Gastroenterology
• Diagnostic Imaging
• Oncology

Background:

• Small bowel tumors are rare and challenging to diagnose, often presenting with obscure gastrointestinal bleeding.
• Conventional imaging modalities may fail to detect these lesions, necessitating advanced diagnostic approaches.

Observation:

• Two cases of small bowel tumors (leiomyomas) presenting with melaena (dark, tarry stools) are described.
• One patient had intermittent bleeding and anemia; the other experienced massive gastrointestinal hemorrhage.
• Initial barium studies were inconclusive in both cases.

Findings:

• Selective visceral arteriography successfully identified a jejunal leiomyoma in the first patient.
• Angiography revealed a large, primarily avascular ileal leiomyoma with cystic degeneration in the second patient.
• Pathological examination confirmed leiomyomas in both cases.

Implications:

• Selective visceral arteriography is a highly valuable tool for diagnosing small bowel tumors, especially when other methods fail.
• This imaging modality aids in precise localization and characterization of lesions, guiding surgical or therapeutic management.
• Early and accurate diagnosis through angiography can significantly improve patient outcomes for small bowel bleeding.