Causes and Clinical Characteristics of Small Bowel Bleeding in Northern Vietnam.

Cong Long Nguyen,Hoai Nam Nguyen,Van Tuyen Pham,Tuan Thanh Nguyen,Anh Tuan Vu,The Phuong Nguyen,Canh Hiep Nguyen,Hoang Nam Nguyen,Khac Khiem Pham,Truong Khanh Vu,Tran Tien Dao,Geoffrey Williams

doi:10.1155/2020/8884092

Abstract

Aim Causes, clinical features, and diagnostic approaches for small bowel (SB) bleeding were analyzed to derive recommendations in dealing with this clinical condition. Methods We included 54 patients undergoing surgical treatment for SB bleeding, from January 2009 to December 2019. Detailed clinical data, diagnosis procedures, and causes of bleeding were collected. Results Among 54 cases with SB bleeding, the most common causes were tumors (64.8%), followed by angiopathy (14.8%), ulcers (9.3%), diverticula (5.6%), tuberculosis (3.7%), and enteritis (1.9%). Most tumors (32/35 cases, 91.4%) and vascular lesions (8/8 cases, 100%) were located in the jejunum. The incidence of tumors was higher in the older (30/41 cases, 73.1%) than that in patients younger than 40 years of age (5/13 cases, 38.5%, P < 0.01). Common initial findings were melena (68.5%) and hematochezia (31.5%). The overall diagnostic yield of computed tomographic enterography (CTE) was 57.4% (31/54 cases), with the figures for tumors, vascular lesions, and inflammatory lesions being 71.4% (25/35 cases), 62.5% (5/8 cases), and 12.5% (1/8 cases), respectively. Double-balloon enteroscopy (DBE) definitively identified SB bleeding sources in 16/22 (72.7%) patients. Conclusion Tumors, angiopathy, ulcers, and diverticula were the most common causes of SB bleeding in Northern Vietnamese population. CTE has a high detection rate for tumors in patients with SB bleeding. CTE as a triage tool may identify patients before double-balloon enteroscopy because of the high prevalence of SB tumors.

Highlights

Small bowel (SB) bleeding, a potentially life-threatening clinical condition, accounts for 5 to10% of all gastrointestinal (GI) bleeding sources [1, 2]
With advances in SB imaging, including video capsule endoscopy (VCE), device-assisted endoscopy, radiographic imaging, and angiography, a SB bleeding source can be identified in the majority of patients (∼75%) previously diagnosed with OGIB
SB bleeding presented for less than 1 month in 33 cases, 1 to12 months in 13 cases, and more than 12 months in 8 cases. e longest duration was 5 years on a patient admitted to the hospital six times because of recurrent suspected SB bleeding, diagnosed with a SB tumor on intraoperative enteroscopy

Summary

Introduction

Small bowel (SB) bleeding, a potentially life-threatening clinical condition, accounts for 5 to10% of all gastrointestinal (GI) bleeding sources [1, 2]. It could occur anywhere between the ligament of Treitz and the ileocecal valve. GI bleeding was referred to as being obscure (OGIB), if no source of hemorrhage was found after initial evaluations, including esophagogastroduodenoscopy (EGD), colonoscopy, and radiologic examination [4]. With advances in SB imaging, including video capsule endoscopy (VCE), device-assisted endoscopy, radiographic imaging, and angiography, a SB bleeding source can be identified in the majority of patients (∼75%) previously diagnosed with OGIB. The American College Of Gastrointestinal (ACG) guideline has proposed the former term OGIB should be reclassified as SB bleeding [3, 5,6,7]

Methods

Results

Conclusion