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.
Costantini
Raffaele
R
Department of General and Laparoscopic Surgery, "G. D'Annunzio" University of Chieti, Italy. r.costantini@unich.it
De Nicola
Pierpaolo
P
Bianco
Francesco
F
Cotroneo
Antonio Raffaele
AR
Iezzi
Roberto
R
Di Bartolomeo
Nicola
N
Innocenti
Paolo
P
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