Surgery for a small intestine haemorrhage with use of a laparoscope for localization of the bleeding site

Abstract

Unlike in other parts of the digestive tract, the localization of a haemorrhage site in the small intestine is difficult. In the case of massive bleeding and the need for an urgent operation, localization of the area or site of bleeding in the small bowel may be challenging for the surgeon. The authors report a method of finding sites of bleeding using a laparoscope in a patient with massive gastrointestinal bleeding. Endoscopic diagnostics were inconclusive and an angio-CT revealed bleeding in the small bowel in the left middle-abdomen. Emergency laparotomy was performed with enterotomy and an inspection of the suspected part of the intestine with a laparoscope. Three sites of bleeding were found, of which one with active bleeding was ligated. Additionally, the small intestine parts over the bleeding sites were devascularized by ligation of arterial branches supporting them. This resulted in the bleeding stopping and the patient eventually recovering. The authors believe that the presented technique may be helpful in intraoperative localization of bleeding sites in the small bowel.