Chung CS, Chen KC, Chou YH, Chen KH. Emergent single-balloon enteroscopy for overt bleeding of small intestinal vascular malformation. World J Gastroenterol 2018; 24(1): 157-160 [PMID: 29358892 DOI: 10.3748/wjg.v24.i1.157]
Corresponding Author of This Article
Chen-Shuan Chung, MD, MSc, Chief Doctor, Lecturer, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Section 2, Banciao District, Taipei 22060, Taiwan. chungchenshuan_3@yahoo.com.tw
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Chen-Shuan Chung, Kuan-Chih Chen, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
Chen-Shuan Chung, College of Medicine, Fu Jen Catholic University, New Taipei City 24205, Taiwan
Chen-Shuan Chung, Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Taoyuan City 33305, Taiwan
Yueh-Hung Chou, Department of Anatomical Pathology, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
Kuo-Hsin Chen, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
Kuo-Hsin Chen, Department of Electrical Engineering, Yuan Ze University, New Taipei City 22060, Taiwan
Author contributions: Chung CS and Chen KC collected data; Chung CS drafted the manuscript; Chou YH reviewed the pathology; Chen KH managed the surgical operations; Chung CS designed and supervised the study; all authors have read and approved the final version to be published.
Informed consent statement: Patient’s privacy is concealed by this retrospective case report and there is no informed consent needed.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chen-Shuan Chung, MD, MSc, Chief Doctor, Lecturer, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Section 2, Banciao District, Taipei 22060, Taiwan. chungchenshuan_3@yahoo.com.tw
Received: October 25, 2017 Peer-review started: October 26, 2017 First decision: November 21, 2017 Revised: December 1, 2017 Accepted: December 4, 2017 Article in press: December 4, 2017 Published online: January 7, 2018 Processing time: 73 Days and 20.1 Hours
Abstract
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 single-balloon enteroscopy was performed at 8 h after clinical overt bleeding occurrence; the procedure revealed a 2-cm pulsating subepithelial tumor with a protruding blood 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.
Core tip: We believe that emergent deep enteroscopy performed with a secure airway and ventilator support can efficiently identify the stigmata of hemorrhage in clinical overt small intestinal bleeding and guide the operative approach.
