Jejunoileal causes of overt gastrointestinal bleeding: diagnosis, management, and outcome.
Major bleeding from the small intestine is uncommon and difficult to localize. We examined its etiologies and assessed available diagnostic and therapeutic approaches. The records of all adults undergoing operation for small intestinal hemorrhage over a 10-year period (1/89-12/98) were reviewed. There were eight men and four women with a mean age of 54 years. Six patients presented with arteriovenous malformations. Preoperative diagnosis was by endoscopy (three of six), scintigraphy (two of two), and/or angiography (two of six). Intraoperative panendoscopy was used for localization in 5 cases. Three other patients had tumors (leiomyoma, leiomyosarcoma, and adenocarcinoma) by CT scan (two) and/or scintigraphy (two). All were resected but one patient died of recurrence. Two patients underwent resection of a Meckel's diverticulum, one after angiographic diagnosis. Another patient with Crohn's disease had a positive angiogram and colonoscopy before resection. There were no operative deaths but major morbidity occurred in five patients (42%) and hospitalization averaged 17 days. We conclude that jejunoileal lesions are a rare cause of intestinal bleeding but can be associated with substantial morbidity. Arteriovenous malformations and tumors remain the most common causes. An accurate diagnosis and definitive management depend on selective preoperative imaging and judicious operative exploration.
Schwesinger
W H
WH
Department of Surgery, University of Texas Health Science Center at San Antonio, 78229-7842, USA.
Sirinek
K R
KR
Gaskill
H V
HV
Velez
J P
JP
Corea
J J
JJ
Strodel
W E
WE
D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001165:Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D003663:Decision Trees; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D007579:Jejunal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D007889:Leiomyoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D007890:Leiomyosarcoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008467:Meckel Diverticulum / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009017:Morbidity; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome