Minimally invasive surgery for obscure idiopathic ileal varices diagnosed by capsule endoscopy and double balloon endoscopy: report of a case.
Small intestinal bleeding is difficult to detect and can be life-threatening. Capsule endoscopy (CE) is a new, minimally invasive diagnostic procedure designed to detect gastrointestinal (GI) bleeding. We report the successful management of idiopathic ileal varices by capsule endoscopy and laparoscopic surgery. Massive bleeding occurred suddenly with intermittent melena, and the patient was finally admitted to a local hospital in hypovolemic shock. Her condition was stabilized with conservative therapy but the site of bleeding was not defined by endoscopy, computed tomography, scintigraphy, or angiography. Thus, she was transferred to our hospital. On admission, CE revealed idiopathic ileal varices, so we performed laparoscopic partial ileal resection immediately. Follow-up CE has shown no evidence of recurrence in the 2 years since surgery. Idiopathic ileal varices are rare, difficult to diagnose, and often fatal. Capsule endoscopy is a minimally invasive diagnostic procedure that detects this disorder in time for laparoscopic surgery to be performed effectively and safely.
Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
Hirotaka
H
Konishi
Shojiro
S
Kikuchi
Atsushi
A
Miyashita
Daisuke
D
Ichikawa
Hitoshi
H
Fujiwara
Takeshi
T
Kubota
Toshiya
T
Ochiai
Yukihito
Y
Kokuba
Satoru
S
Yasukawa
Satoshi
S
Yasukawa
Akio
A
Yanagisawa
Eigo
E
Otsuji
D016888:Angiodysplasia / Q000175:diagnosis; D053704:Capsule Endoscopy / Q000295:instrumentation / Q000379:methods*; D004108:Dilatation, Pathologic / Q000175:diagnosis; D058582:Double-Balloon Enteroscopy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007082:Ileum / Q000098:blood supply*; D010535:Laparoscopy / Q000379:methods*; D008551:Melena / Q000209:etiology; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014648:Varicose Veins / Q000150:complications / Q000175:diagnosis* / Q000601:surgery