title: Recurrent gastrointestinal bleeding of obscure origin: report of 17 cases and a guide to logical management.
abstract: Seventeen patients with chronic obscure gastrointestinal bleeding presenting over a 5-year period are described. While representing only 6 per cent of the total number of admissions due to gastrointestinal haemorrhage they required a disproportionate amount of medical attention, including 67 admissions, 73 radiological and 56 endoscopic procedures and transfusion of a total of 198 units of blood. The diagnoses included 5 cases of recurrent acute upper gastrointestinal erosions, 7 small bowel abnormalities and 4 colonic lesions, with 1 patient undiagnosed. Eight arteriovenous malformations (AVM) were demonstrated angiographically and one Meckel's diverticulum identified by a 99Tcm pertechnetate scan. There were 5 cases in which laparotomy yielded the final diagnosis and in one of these peroperative endoscopy of the small bowel was required. On the basis of our experience and a review of other series, a logical plan of investigation is described for such difficult cases.
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D002908:Chronic Disease; D003108:Colonic Diseases / Q000175:diagnosis; D004378:Duodenal Diseases / Q000175:diagnosis; D004724:Endoscopy; D004733:Enema; D005260:Female; D005756:Gastritis / Q000175:diagnosis; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis; D007421:Intestine, Small; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013667:Technetium
chemical_list: D013667:Technetium