Variceal bleeding from ileum identified and treated by single balloon enteroscopy

Traina, Mario; Tarantino, Ilaria; Barresi, Luca; Mocciaro, Filippo

doi:10.3748/wjg.15.1904

Cited by 21 publications

(14 citation statements)

References 11 publications

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“…4,5 Other causes include tumors, which are considered the most common source of OGIB in patients Ͻ50 years old (eg, leiomyomas, carcinoid tumors, lymphomas, and adenocarcinomas), 6 Meckel's diverticulaassociated ulceration (especially in younger patients), 7,8 radiation enteropathy, 9 Dieulafoy's lesions, 10 hemosuccus pancreaticus, 11 and small-bowel varices. [12][13][14] OGIB may occur anywhere throughout the GI tract. Prior to evaluation of the small bowel, upper and lower GI tract endoscopies are often repeated in patients with OGIB because substantial initial endoscopic miss rates have been reported.…”

Section: Introductionmentioning

confidence: 99%

The role of endoscopy in the management of obscure GI bleeding

Fisher¹,

Krinsky²,

Anderson³

et al. 2010

Gastrointestinal Endoscopy

228

103

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Section: Introductionmentioning

confidence: 99%

The role of endoscopy in the management of obscure GI bleeding

Fisher¹,

Krinsky²,

Anderson³

et al. 2010

Gastrointestinal Endoscopy

228

103

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“…13 Rare causes of small-bowel bleeding include Meckel's diverticula-associated ulceration (especially in younger patients), 14 radiation enteropathy, 15 Dieulafoy's lesions, 16,17 small-bowel varices, and aortoenteric fistulas. 18,19 In patients with OGIB, upper and lower GI tract endoscopies often are repeated before small-bowel evaluation because substantial initial endoscopic miss rates have been reported. 20,21 Techniques for evaluation of the small bowel include VCE, DAE, multiphase CT enterography (CTE), magnetic resonance enterography (MRE), and, in rare instances, intraoperative enteroscopy.…”

mentioning

confidence: 99%

The role of endoscopy in the management of suspected small-bowel bleeding

Gurudu¹,

Bruining²,

Acosta³

et al. 2017

Gastrointestinal Endoscopy

130

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“…With the advent of capsule endoscopy (CE), it is now possible to examine the entire small intestine without discomfort to the patient and on an outpatient ambulatory basis. This method does not, however, permit biopsies nor treatment, a limitation that has been overcome by double and single-balloon enteroscopy [2].…”

Section: Discussionmentioning

confidence: 99%

Bleeding ileal varices: a rare cause of chronic anemia in liver cirrhosis

et al. 2010

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A 70-year-old man was admitted to our hospital for severe microcytic anemia (Hb 5.9 g/dL, MCV 74 fl). The medical history included hepatic cirrhosis due to previous alcohol abuse with known portal hypertension, hemorrhoids and oesophageal varices. During the prior year, he had been admitted three times to the hospital due to ascites, treated with evacuative paracentesis for his microcytic anemia with low ferritinemia, each time he was transfused with blood and treated for 2 months with oral iron for an improvement in the hemoglobin level and in iron metabolism parameters. Two esophagogastroduodenoscopies (EGDs) and two colonoscopies did not show bleeding lesions, and even faecal occult blood testing was negative on multiple samples.He was on treatment with canrenoate 400 mg/die, furosemide 25 mg/die, and propranolol 80 mg/die. During immediate prior weeks, he reported general malaise, heart palpitations and weakness. He did not report any blood loss with stool, nor hematuria or hematemesis. He was afebrile, and the other vital signs were normal. He was pale, and there was no jaundice. Abdominal ultrasonography (US) showed slight free peritoneal fluid. He was initially transfused with two units of packed red blood cells and an intravenous administration of iron was started. The faecal occult blood test on three samples was negative, a new EGDs showed oesophageal varices without signs of recent bleeding; colonoscopy revealed a normal mucosa with hemorrhoids.In order to study the entire intestine, capsule endoscopy (CE) was performed; it revealed severe hyperemia of jejunoileal mucosa with multiple big blue varices in the ileum, without active bleeding (Fig. 1).Due to the persistence of anemia, and the need for frequent blood transfusion, along with a lack of response to betablockers, a transjugular intrahepatic portosystemic shunt (TIPSS) procedure was performed with no complications. The patient underwent a CE 5 days after showing the disappearance of the multiple varices (Fig. 2); the anemia improved quickly, and no further blood transfusion has been necessary up to the present. DiscussionPortal hypertensive enteropathy (PHE) is present in 5-11% of patients with portal hypertension and chronic active bleeding [1]; the presence of varices and of areas of mucosa with a reticulate pattern should be considered manifestations of portal hypertension in the small bowel. Ectopic varices are an unusual cause of gastrointestinal hemorrage and can account for up to 5% of variceal bleeding; acute bleeding is associated with a high mortality. These varicescan occur at different sites in the gastrointestinal tract, including the duodenum, small bowel, colon and peristomal locations.Endoscopic diagnosis of ileal PHE and ileal varices is impossible to achieve with a standard endoscope, and

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Variceal bleeding from ileum identified and treated by single balloon enteroscopy

Cited by 21 publications

References 11 publications

The role of endoscopy in the management of obscure GI bleeding

The role of endoscopy in the management of obscure GI bleeding

The role of endoscopy in the management of suspected small-bowel bleeding

Bleeding ileal varices: a rare cause of chronic anemia in liver cirrhosis

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