Emergent single-balloon enteroscopy for overt bleeding of small intestinal vascular malformation

作     者：Chen-Shuan Chung Kuan-Chih Chen Yueh-Hung Chou Kuo-Hsin Chen 

作者机构：Division of Gastroenterology and HepatologyDepartment of Internal MedicineFar Eastern Memorial HospitalNew Taipei City 22060Taiwan College of MedicineFu Jen Catholic UniversityNew Taipei City 24205Taiwan Taiwan Association for the Study of Small Intestinal Diseases(TASSID)Taoyuan City 33305Taiwan Department of Anatomical PathologyFar Eastern Memorial HospitalNew Taipei City 22060Taiwan Department of SurgeryFar Eastern Memorial HospitalNew Taipei City 22060Taiwan Department of Electrical EngineeringYuan Ze UniversityNew Taipei City 22060Taiwan 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2018年第24卷第1期

页      面：157-160页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Early endoscopy Small intestine Deep enteroscopy Device-assisted enteroscopy Obscure gastrointestinal bleeding Vascular malformation 

摘      要：A 28-year-old man presented with anemia symptoms and intermittent tarry stool passage for three days. No stigmata of hemorrhage were identified using esophagogastroduodenoscopy, ileocolonoscopy, and contrast-enhanced computed tomography. He then developed massive tarry stool passage with profound hypovolemic shock and hypoxic respiratory failure. Emergent angiography revealed active bleeder, probably from the jejunal branches of the superior mesenteric artery, but embolization was not performed due to possible subsequent extensive bowel ischemia. His airway was secured via endotracheal intubation with ventilator support, and emergent antegrade singleballoon enteroscopy was performed at 8 h after clinical overt bleeding occurrence; the procedure revealed a 2-cm pulsating subepithelial tumor with a protrudingblood plug at the distal jejunum. Laparoscopic segmental resection of the jejunum with end-to-end anastomosis was performed after emergent endoscopic tattooing localization. Pathological examination revealed a vascular malformation in the submucosa with an organizing thrombus. He was uneventfully discharged 5 d later. This case report highlights the benefit of early deep enteroscopy for the treatment of small intestinal bleeding.