Obscure gastrointestinal bleeding: <scp>D</scp>iagnosis and treatment

Ohmiya, Naoki; Nakagawa, Yoshihito; Nagasaka, Mitsuo; Tahara, Tomomitsu; Shibata, Tomoyuki; Nakamura, Masanao; Hirooka, Yoshiki; Goto, Hidemi; Hirata, Ichiro

doi:10.1111/den.12423

Cited by 48 publications

(40 citation statements)

References 68 publications

(141 reference statements)

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“…described that tarry stools were mostly of upper GI, jejunal, or ileal origins, whereas bright or dark red stools were often of ileal or colorectal origins. Although acute massive bleeding in the upper GI tract or bleeding of jejunal lesions causes reddish bloody stools, and a small volume of bleeding in ileal or colonic lesions causes black stools, especially in constipated patients, the color and properties of the stool are often considered helpful in predicting the locations of lesions . Complicated abdominal pain or distention suggests small‐intestinal invagination or stenosis as a result of tumors or inflammation, such as Crohn’s disease and intestinal tuberculosis.…”

Section: Diagnosismentioning

confidence: 99%

Management of obscure gastrointestinal bleeding: Comparison of guidelines between Japan and other countries

Ohmiya

2019

Digestive Endoscopy

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Small‐bowel bleeding accounts for the majority of obscure gastrointestinal bleeding, but it is caused by various types of small bowel disease, upper gastrointestinal disease, and colorectal disease. For the diagnosis, history taking and physical examination are required, leading to a determination of what diseases are involved. Next, cross‐sectional imaging, such as computed tomography, should be carried out, followed by the latest enteroscopy such as small bowel capsule endoscopy and deep enteroscopy according to the severity of hemorrhage and patient condition. After a comprehensive diagnosis, medical, enteroscopic, or surgical treatment should be selected. This article reviews recent advances in the endoscopic diagnosis of obscure gastrointestinal bleeding and compares perspectives of the management of obscure gastrointestinal bleeding in Japan with that in other countries.

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Section: Diagnosismentioning

confidence: 99%

Management of obscure gastrointestinal bleeding: Comparison of guidelines between Japan and other countries

Ohmiya

2019

Digestive Endoscopy

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“…De acuerdo a la expresión clínica, la hemorragia gastrointestinal se clasifica en manifiesta y oculta, y según la localización se cataloga como alta y baja; esta es de origen oscuro cuando persiste o aparece el sangrado después de realizar endoscopia de vías digestivas altas y colonoscopia negativas (8). Con el advenimiento de técnicas endoscópicas y radiológicas que evalúan el intestino delgado, en los último años se ha propuesto la definición de sangrado probable de intestino delgado o sangrado gastrointestinal intermedio para los pacientes a quienes se realiza endoscopia digestiva alta y colonoscopia negativas, reservando el término sangrado de origen oscuro para los pacientes en quienes el origen de la hemorragia no se ha identificado posterior a realizar endoscopia digestiva alta, colonoscopia y estudios de intestino delgado como videocápsula endoscópica, enterografía por tomografía o resonancia magnética, angiografía, gammagrafía, enteroscopia de empuje, enteroscopia profunda con balón o en espiral, o enteroscopia intraoperatoria (9).…”

Section: Discussionunclassified

Neurofibromatosis tipo 1 y sangrado de intestino delgado. Reporte de caso

Gómez-Zuleta

Lúquez-Mindiola

2017

Rev. Fac. Med.

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REPORTE DE CASO | Resumen |La neurofibromatosis tipo 1, o enfermedad de von Recklinghausen, es un desorden neurocutáneo hereditario con compromiso gastrointestinal en el 5-25% de los pacientes, siendo sintomático solo el 5%; se presenta posterior a las manifestaciones cutáneas y afecta en su mayoría el yeyuno. Los síntomas de esta enfermedad son dolor abdominal, obstrucción intestinal, perforación, diarrea, masa palpable y sangrado gastrointestinal alto o bajo.A continuación se reporta el caso de una mujer con sangrado gastrointestinal manifiesto secundario a neurofibromas plexiformes en yeyuno y se realiza una breve revisión de la literatura sobre compromiso gastrointestinal. | Abstract | Neurofibromatosis type 1, also known as von Recklinghausen disease, is an inherited neurocutaneous disorder with gastrointestinal involvement in 5-25% of patients, with only 5% being symptomatic; it develops following cutaneous manifestations and mostly affects the jejunum. The symptoms include abdominal pain, intestinal obstruction, perforation, diarrhea, palpable mass and high or low gastrointestinal bleeding.The following report presents the case of a woman with manifest gastrointestinal bleeding secondary to plexiform neurofibromas in the jejunum, as well as a brief review of the literature on gastrointestinal involvement. Keywords IntroducciónLa neurofibromatosis tipo 1, también llamada enfermedad de von Recklinghausen, es un desorden hereditario autosómico dominante en el cual se desarrollan tumores benignos y malignos en el sistema nervioso central y periférico que afectan varias partes del cuerpo. Esta enfermedad la describe por primera vez en 1882 el patólogo alemán Frederich von Recklinghausen (1) y en la actualidad su prevalencia es cercana a 1 por cada 3 000 habitantes, con mayor presencia en niños (2). En la etiopatogenia de esta enfermedad está involucrada la mutación del gen NF-1, un gen supresor tumoral que se localiza en el cromosoma 17q11.2 y codifica la neurofibromina (3).Los criterios diagnósticos de la neurofibromatosis tipo 1 se publican en 1988 en la última conferencia de consenso del Instituto Nacional de Salud de los Estados Unidos (4); sin embargo, en la actualidad hay propuestas de modificarlos dado el avance en el entendimiento de la enfermedad, la disponibilidad de análisis moleculares precisos y nuevos signos clínicos (5).La neurofibromatosis tipo 1 se caracteriza por manchas color café con leche, efélides axilares o inguinales, neurofibromas plexiformes, nódulos de Lisch (hamartomas del iris), lesiones óseas (displasia del ala del esfenoides, displasia de huesos largos y escoliosis) y glioma óptico (1).La frecuencia de manifestaciones intraabdominales varía entre el 5% y el 25% de los pacientes y solo el 5% son sintomáticos, presentándose por lo general tardío en la enfermedad y posterior a las manifestaciones cutáneas (6). Los síntomas dependen del sitio de compromiso gastrointestinal, y son, en su mayoría, dolor abdominal, obstrucción intestinal, perforación, diarrea, masa palpable y sangrado ...

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“…Robles et al (9) reported that the histological detection rate of GISTs by DBE biopsy was 71.4%. The first-line treatment for small intestinal GISTs with excessive bleeding remains debatable (10,11). The endoscopic treatment by DBE is very limited in massive GIST bleeding, but it may be possible, delaying or averting emergency surgery (9).…”

Section: Discussionmentioning

confidence: 99%

Emergency surgery for hemorrhagic shock caused by a gastrointestinal stromal tumor of the ileum: A case report

Shimazaki

Tabuchi

Nishida

et al. 2016

Molecular and Clinical Oncology

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Abstract. In this report, a case of hemorrhagic shock caused by a gastrointestinal stromal tumor (GIST) of the ileum, which was successfully treated by emergency surgery, is presented. A 67-year-old male patient presented to the Ibaraki Medical Center, Tokyo Medical University (Ami, Japan) in July 18, 2014, with dizziness and blood in the stool. Upper endoscopy and colonoscopy failed to reveal the source of the hemorrhage, although abdominal contrast-enhanced computed tomography revealed extravasation of the contrast medium into the small intestine. The patient developed hemorrhagic shock; thus, double-balloon enteroscopy (DBE) was performed, which revealed a Meckel's diverticulum and a submucosal tumor with excessive bleeding at 60 and 100 cm proximal to the ileocecal valve, respectively. Subsequent emergency partial resection of the ileum, including the tumor and the Meckel's diverticulum, was performed in July 20, 2014. Histological examination of the excised tumor revealed proliferation of spindle-shaped cells, and immunohistochemical staining of the tumor was positive for CD34, KIT and α-smooth muscle actin, but negative for S-100 protein. These immunohistological results supported the diagnosis of GIST of the ileum. The patient had an uneventful recovery and has been monitored at our outpatient clinic for 14 months after surgery. This case demonstrated the efficacy of DBE for the diagnosis of small intestinal bleeding, and immediate emergency surgery should be considered for cases of small intestinal GISTs with excessive bleeding. IntroductionGastrointestinal stromal tumors (GISTs) are rare tumors that may arise from any site of the GI tract and are generally associated with abdominal pain, GI bleeding, or a palpable mass. However, a small intestinal GIST rarely causes hemorrhagic shock. We herein report a case of hemorrhagic shock with excessive bleeding caused by an ileal GIST that was managed by emergency surgery. The patient provided written informed consent for the publication of this case report. Case reportA 67-year-old male patient presented to the Department of Gastroenterology of the Ibaraki Medical Center, Tokyo Medical University (Ami, Japan) in July 18, 2014, with dizziness and blood in the stool. The patient's medical history included treatment for hypertension by a local physician. The findings of the subsequent physical examination were unremarkable, except for low blood pressure (97̸60 mmHg) and mild pallor of the palpebral conjunctiva. Laboratory data revealed mild anemia (hemoglobin, 10.2 g̸dl) and increased blood urea nitrogen (34.1 mg̸dl). Upper endoscopy revealed no hemorrhagic lesion of the duodenum, stomach, or esophagus. Colonoscopy revealed fresh blood with clotting discharged from the proximal side of the ileocecal valve; no hemorrhagic lesion of the colon or rectum was identified. Abdominal contrast-enhanced computed tomography (CT) revealed extravasation of the contrast medium into the small intestine (Fig. 1). The intestinal bleeding continued, and the patient eventually devel...

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Obscure gastrointestinal bleeding: Diagnosis and treatment

Cited by 48 publications

References 68 publications

Management of obscure gastrointestinal bleeding: Comparison of guidelines between Japan and other countries

Management of obscure gastrointestinal bleeding: Comparison of guidelines between Japan and other countries

Neurofibromatosis tipo 1 y sangrado de intestino delgado. Reporte de caso

Emergency surgery for hemorrhagic shock caused by a gastrointestinal stromal tumor of the ileum: A case report

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