Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec;22(12):2326-2329.
doi: 10.1111/codi.15348. Epub 2020 Sep 22.

Intra-operative enteroscopy for the identification of obscure bleeding source caused by gastrointestinal angiodysplasias: through a balloon-tip trocar is better

D Tartaglia  1 , A Mazzoni  1 , A G Puglisi  1 , F Coccolini  1 , M Chiarugi  1
Affiliations

Intra-operative enteroscopy for the identification of obscure bleeding source caused by gastrointestinal angiodysplasias: through a balloon-tip trocar is better

D Tartaglia et al. Colorectal Dis. 2020 Dec.

Abstract

Aim: Intra-operative enteroscopy (IE) is a valid diagnostic tool which can be adopted in order to identify the precise location of bleeding gastrointestinal angiodysplasias (GIADs) of the small bowel. We describe a novel IE technique that may increase the diagnostic yield by maintaining a steady distension of the bowel and that prevents microtrauma to the intestinal mucosa and spillage of enteric content into the operative field.

Methods: After laparotomy, a centimetric transverse enterotomy is performed approximately at the middle of the small bowel. A 12-mm trocar with balloon is then introduced and insufflated. The small bowel is gently distended by carbon dioxide insufflation. Through the trocar, a paediatric colonscope is then inserted and the enteroscopy is performed either retrogradely to the duodenum or anterogradely to the caecum. Once located, surgery is tailored to the precise site of bleeding, with a consequent sparing of intestinal resection.

Results: IE with 12-mm trocar with balloon was adopted in four elderly patients undergoing surgery for bleeding GIADs. The length of small bowel resection ranged from 10 to 200 cm, depending on the number of GIADs. Operating time ranged from 210 to 275 min. Intra-operative blood loss was nil. No patient developed organ-space or wound infections. There was no recurrence of bleeding from the midgut.

Conclusion: Performing IE through a balloon trocar may increase the diagnostic accuracy of the procedure with the benefit of reducing the risk of traumatic injury to the bowel and the risk of surgical site infection.

Keywords: gastrointestinal angiodysplasias; intestinal resection; intra-operative enteroscopy; laparoscopic trocar; lower gastrointestinal bleeding.

PubMed Disclaimer

References

    1. Rockey DC, Koch J, Cello JP, Sanders LL, McQuaid K. Relative frequency of upper gastrointestinal and colonic lesions in patients with positive fecal-occult blood tests. N Eng J Med 1998; 339: 153-9.
    1. Schmith A, Gay F, Adler M, Cremer M, Van Gossum A. Diagnostic efficacy of push enteroscopy and long term follow up of patients with small bowel angiodysplasia. Dig Dis Sci 1996; 41: 2348-52.
    1. Holleran G, McNamara D. An overview of angiodysplasia: management and patient prospects. Expert Rev Gastroenterol Hepatol 2018; 12: 863-72.
    1. Davie M, Yung ED, Douglas S, Plevris NJ, Koulaouzidis A. Mapping the distribution of small bowel angioectasias. Scand J Gastroenterol 2019; 54: 597-602.
    1. Samaha E, Rahmi G, Landi B et al. Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions. Am J Gastroenterol 2012; 107(2): 240-6.

LinkOut - more resources