title: Use of intraoperative endoscopy to localize bleeding in the small intestine.
abstract: BACKGROUND
  Bleeding within the small intestine is difficult to diagnose and localize because it typically occurs at a slow rate. These patients may undergo multiple transfusions and repeated endoscopy, contrast studies, bleeding scans, and angiography before the bleeding source is identified.
  
  
  METHODS
  We report a case of 64-year-old woman, where both endoscopic and angiographic techniques were used to localize protracted bleeding. During endoscopic treatment, the arteriovenous malformations continued bleeding. However, highly selective angiography and intraoperative endoscopy outlined the segments of small intestine for resection. This case reviews the evaluation, localization and treatment of small intestine bleeding.
  
  
  CONCLUSIONS
  Localizing the site of protracted bleeding in the small intestine beyond the duodenum bulb can be problematic. For some patients, the course of examinations and transfusions can take years. The small intestine is an uncommon site for gastrointestinal hemorrhage, and only 3%-5% of gastrointestinal bleeding occurs between the ligament of Treitz and the ileocecal valve. The length and location of the small intestine, along with other anatomical factors, make this area difficult to assess with endoscopy or radiology. In this case of protracted bleeding, highly selective angiography and intraoperative endoscopy were used to locate the source of the bleeding.
authors.affiliation: Dipartimento di Chirurgia D'Urgenza, Senologica e dei Trapianti, Policlinico Tor Vergata, Roma, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Manzelli
authors.forename: Piero
authors.initials: P
authors.lastname: Rossi
authors.forename: Athanasios
authors.initials: A
authors.lastname: Petrou
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Sica
authors.forename: Edoardo
authors.initials: E
authors.lastname: Ricciardi
authors.forename: Paris
authors.initials: P
authors.lastname: Pappas
mesh_terms: D000792:Angiography; D001165:Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D007583:Jejunum / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D016896:Treatment Outcome