title: Protein C deficiency related obscure gastrointestinal bleeding treated by enteroscopy and anticoagulant therapy.
abstract: Obscure gastrointestinal bleeding is an uncommonly encountered and difficult-to-treat clinical problem in gastroenterology, but advancements in endoscopic and radiologic imaging modalities allow for greater accuracy in diagnosing obscure gastrointestinal bleeding. Ectopic varices account for less than 5% of all variceal bleeding cases, and jejunal variceal bleeding due to extrahepatic portal hypertension is rare. We present a 47-year-old man suffering from obscure gastrointestinal bleeding. Computed tomography of the abdomen revealed multiple vascular tufts around the proximal jejunum but no evidence of cirrhosis, and a visible hypodense filling defect suggestive of thrombus was visible in the superior mesenteric vein. Enteroscopy revealed several serpiginous varices in the proximal jejunum. Serologic data disclosed protein C deficiency (33.6%). The patient was successfully treated by therapeutic balloon-assisted enteroscopy and long-term anticoagulant therapy, which is normally contraindicated in patients with gastrointestinal bleeding. Diagnostic modalities for obscure gastrointestinal bleeding, such as capsule endoscopy, computed tomography enterography, magnetic resonance enterography, and enteroscopy, were also reviewed in this article.
authors.affiliation: Wei-Fan Hsu, Chung-Jen Teng, Chen-Shuan Chung, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan.
authors.forename: Wei-Fan
authors.initials: WF
authors.lastname: Hsu
authors.affiliation: Wei-Fan Hsu, Chung-Jen Teng, Chen-Shuan Chung, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan.
authors.forename: Yuk-Ming
authors.initials: YM
authors.lastname: Tsang
authors.affiliation: Wei-Fan Hsu, Chung-Jen Teng, Chen-Shuan Chung, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan.
authors.forename: Chung-Jen
authors.initials: CJ
authors.lastname: Teng
authors.affiliation: Wei-Fan Hsu, Chung-Jen Teng, Chen-Shuan Chung, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan.
authors.forename: Chen-Shuan
authors.initials: CS
authors.lastname: Chung
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016558:Hemostasis, Endoscopic; D006801:Humans; D007583:Jejunum / Q000098:blood supply*; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000188:drug therapy / Q000209:etiology; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D020151:Protein C Deficiency / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014648:Varicose Veins / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000925:Anticoagulants
keywords: Angiography; Computed tomography; Enteroscopy; Obscure gastrointestinal bleeding; Protein C deficiency; Superior mesenteric venous thrombosis