Tumor vs non-tumor origin of occult and obscure gastrointestinal bleeding requiring hospitalization.
OBJECTIVE
Occult/obscure gastrointestinal bleeding is often problematic to diagnose. It often leads to delayed treatment, a particularly dangerous circumstance when tumor origins are involved. This study reports the six-year experience of an Italian Surgery Center in the identification of the nature (tumor versus non tumor) and site of origin (upper, middle, lower gastrointestinal tract) of occult/obscure bleeding requiring hospitalization, as well as in its treatment.


METHODS
Diagnostic instrumental examinations employed were: esophagogastroduodenoscopy, rectocolonoscopy, computerized tomography small bowel follow-through examination, capsule endoscopy, biopsy, angiography, abdominal computerized tomography scans and ultrasound. Therapies included: interventional radiology and surgery.


RESULTS
Thirty-five cases of obscure and 27 cases of occult bleeding were examined; all received a definite diagnosis during hospitalization. In the cases with obscure bleeding the diagnosis was inflammatory bowel disease (n = 7), angiodysplasia (5 gastric, 2 duodenal, 2 jejunal, 3 ileal, 4 right colon), small bowel tumors (4 non-Hodgkin lymphomas, 1 leiomyoma, 6 adenocarcinomas), and gastric metaplasia of Meckel's diverticulum (n = 1). There were significantly more nontumor lesions than tumors (P < 0.005), and a middle tract source was significantly more frequent than upper/lower tract sources (P < 0.0001). Intestinal resections were performed for all small bowel tumors (8 laparotomic, 3 laparoscopic), 5 angiodysplasias, all cases of inflammatory bowel disease and gastric metaplasia of Meckel's diverticulum; arterial embolization was performed for 11 angiodysplasias. In the cases with occult bleeding the diagnosis was sigmoid colon polyps in 6 (treatment, endoscopic polypectomy) and right colon cancer in 21 (treatment, right hemicolectomy). There were significantly more tumors than nontumor lesions (P < 0.0001); all derived from the lower gastrointestinal tract. In all cases, the interventions resolved the bleeding completely.


CONCLUSIONS
The results show that more than 50% of cases with obscure/occult bleeding requiring hospitalization are motivated by malignant gastrointestinal tumors, 34% of which are located in the small bowel, usually a difficult tract to explore. Thanks to modern technology, however, their diagnosis and treatment can nowadays be promptly and successfully achieved.
Department of General and Laparoscopic Surgery, "G. D'Annunzio" University of Chieti, Italy. r.costantini@unich.it
Raffaele
R
Costantini
Pierpaolo
P
De Nicola
Francesco
F
Bianco
Antonio Raffaele
AR
Cotroneo
Roberto
R
Iezzi
Nicola
N
Di Bartolomeo
Paolo
P
Innocenti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002214:Capsules; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D016896:Treatment Outcome; D014743:Videotape Recording
D002214:Capsules