Computed tomography enteroclysis for recurrent severe gastrointestinal bleeding in a patient with vascular malformation of the small bowel.
This is a case study of a 66-year-old woman who had a vascular malformation of the small bowel that was visualized on computed tomography enteroclysis (CTE). She presented with repeated tarry stool and severe anemia. Although the source of bleeding was not identified on upper and lower gastrointestinal endoscopy, active bleeding was revealed by capsule endoscopy in the deep jejunum. The cause of bleeding was not found on capsule endoscopy. CTE was requested as double-balloon endoscopy would have been difficult because of strong adhesion of the small intestine. A continual subtle vascular malformation of the jejunum, starting from the third jejunal branch end, was demonstrated on CTE with dynamic contrast enhancement. Because this vascular malformation was considered the cause of small intestinal bleeding, selective arterial coil embolization was performed. After embolization, the repeated tarry stool disappeared and the severe anemia dramatically improved. CTE may be a safe and useful method for determining the cause of small intestinal bleeding and for subsequent therapy.
Shimizu
Kensaku
K
Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Japan. kensaku1@yamaguchi-u.ac.jp
Hashimoto
Shinichi
S
Washida
Yasuo
Y
Onoda
Hideko
H
Matsunaga
Naofumi
N
Higaki
Shingo
S
Fujiwara
Keiko
K
Fujita
Takeshi
T
Yamatogi
Shigenari
S
Kato
Masatoshi
M
Hashimoto
Kazuo
K
Sakaida
Isao
I
D000368:Aged; D000740:Anemia / Q000209:etiology; D003287:Contrast Media; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007421:Intestine, Small / Q000098:blood supply*; D011856:Radiographic Image Enhancement / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods; D012008:Recurrence; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*; D054079:Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy
D003287:Contrast Media