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Review
. 2014 Nov;2(4):262-75.
doi: 10.1093/gastro/gou025. Epub 2014 May 29.

Small bowel bleeding: a comprehensive review

Deepak Gunjan  1 , Vishal Sharma  1 , Surinder S Rana  2 , Deepak K Bhasin  1
Affiliations
Review

Small bowel bleeding: a comprehensive review

Deepak Gunjan et al. Gastroenterol Rep (Oxf). 2014 Nov.

Abstract

The small intestine is an uncommon site of gastro-intestinal (GI) bleeding; however it is the commonest cause of obscure GI bleeding. It may require multiple blood transfusions, diagnostic procedures and repeated hospitalizations. Angiodysplasia is the commonest cause of obscure GI bleeding, particularly in the elderly. Inflammatory lesions and tumours are the usual causes of small intestinal bleeding in younger patients. Capsule endoscopy and deep enteroscopy have improved our ability to investigate small bowel bleeds. Deep enteroscopy has also an added advantage of therapeutic potential. Computed tomography is helpful in identifying extra-intestinal lesions. In cases of difficult diagnosis, surgery and intra-operative enteroscopy can help with diagnosis and management. The treatment is dependent upon the aetiology of the bleed. An overt bleed requires aggressive resuscitation and immediate localisation of the lesion for institution of appropriate therapy. Small bowel bleeding can be managed by conservative, radiological, pharmacological, endoscopic and surgical methods, depending upon indications, expertise and availability. Some patients, especially those with multiple vascular lesions, can re-bleed even after appropriate treatment and pose difficult challenge to the treating physician.

Keywords: aetiology; diagnostic approach; management; small intestine bleed.

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Figures

Figure 1.
Figure 1.
Patient of small bowel bleeding due to angiodysplasia in jejunum a: Capsule endoscopy: angiodysplasia in jejunum; b: Enteroscopy: angiodysplasia in jejunum; c: Argon plasma coagulation (APC) of angiodysplasia.
Figure 2.
Figure 2.
Capsule endoscopy: Small ulcers in Crohn’s disease.
Figure 3.
Figure 3.
Capsule endoscopy: Large ulcer in Crohn’s disease.
Figure 4.
Figure 4.
Capsule endoscopy: Ulcer with narrowing in intestinal tuberculosis.
Figure 5.
Figure 5.
Capsule endoscopy: Ulcer with diaphragm in NSAID abuse.
Figure 6.
Figure 6.
Capsule endoscopy: Hookworm.
Figure 7.
Figure 7.
Our approach to small intestinal bleeding *Meckel’s scan in young patient; CE: capsule endoscopy, CECT: contrast enhanced CT, CTA: CT angiography, IOE: intra-operative enteroscopy.
See this image and copyright information in PMC

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