title: Methylene blue dye injection for identification of occult gastrointestinal bleeding.
abstract: The exact site of small bowel bleeding is difficult to detect intraoperatively. We present a simple method of on-table identification of the site of the bleed. A 55-year-old lady presented with recurrent episodes of melena and drop in hemoglobin. Digital subtraction angiography (DSA) revealed angiodysplasia of a vessel supplying the proximal jejunum. A microcatheter was placed at this site in the DSA suite, just prior to laparotomy. Two cubic centimeters of methylene blue dye was injected into the microcatheter on-table which demarcated the 6 in. of involved jejunum which was then resected. Patient is currently doing well over a 6-month follow up with no further episodes of melena. In conclusion, preoperative DSA and selective catheterization of the affected vessel allow for on-table localization of the exact site of bleed. This simple method avoids more invasive techniques of detection and enables limited segmental resection of the affected bowel.
authors.affiliation: Division of Gastrointestinal Surgery, P D Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mumbai, 400 016, India.
authors.forename: Adrianna
authors.initials: A
authors.lastname: D'Mello
authors.forename: Abhijeet D
authors.initials: AD
authors.lastname: Sawant
authors.forename: Anirudha
authors.initials: A
authors.lastname: Kulkarni
authors.forename: Anand
authors.initials: A
authors.lastname: Joshi
authors.forename: Sudeep R
authors.initials: SR
authors.lastname: Shah
mesh_terms: D016888:Angiodysplasia / Q000150:complications / Q000000981:diagnostic imaging*; D015901:Angiography, Digital Subtraction / Q000379:methods*; D002404:Catheterization; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007583:Jejunum / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging* / Q000601:surgery; D008751:Methylene Blue; D008875:Middle Aged; D009780:Occult Blood; D016896:Treatment Outcome
chemical_list: D008751:Methylene Blue