Small bowel melaena: 2 cases diagnosed by angiography

Abstract

Two cases of small bowel tumour presenting with melaena are reported. Selective visceral arteriography was found to be invaluable in the management of these cases. The first case presented with intermittent bleeding causing anaemia. Conventional barium studies of the small and large bowel revealed no abnormality. Superior mesenteric angiography revealed a mass lesion in the jejunum, with features characteristic of a leiomyoma. The second case presented with massive gastrointestinal bleeding. Selective visceral angiography was performed initially and revealed a large, mainly avascular, mass lesion in the ileum. Pathological examination showed a leiomyoma which had undergone cystic degeneration. The value of selective angiography in patients with suspected small bowel bleeding is discussed..

Gastrointestinal haemorrhage from leiomyomata of the small bowel

“…When bleeding occurs, it is usually associated with mucosal ulceration or cavitation. One or the other of these features was observed in all 3 cases, a common finding shared by others (Forbes et al, 1978;Christou, Stein and Meakins, 1979).…”

“…Although all these features need not be present in each case, the vascular pattern is quite constant. Using this technique, leiomyomata have been demonstrated in bleeding patients even when barium studies are negative (Burrows, Dodds, and Thompson, 1977;Forbes et al, 1978). In acute gastrointestinal haemorrhage, angiography is more likely to succeed if there is active bleeding exceeding 05 ml/min., and if contrast is injected into the appropriate feeding vessel (Gordan, Herlinger and Baum, 1981).…”

Two Cases of Gastrointestinal Bleeding

“…Despite the many reports of success in using angiography in similar cases (Ramer, 1971;Klein, 1971;Forbes, 1978) neither patient underwent angiography. The lady had had duodenoscopy, colonscopy (twice) and gastrografin enema.…”