SMALL INTESTINAL BLEEDING
Section snippets
Vascular Lesions of the Small Bowel
A variety of causes of small bowel bleeding may be encountered, each with its own bleeding pattern (Table 1). Vascular lesions are the commonest cause of small intestinal bleeding, accounting for 70% to 80%.82 Vascular lesions of the bowel are not all the same. Although most vascular lesions appear endoscopically similar and can be a cause of bleeding, they consist of various pathologic identities, as follows81:
Angiodysplasia (vascular ectasia)
Sporadic
Associated with renal
Radiology
Small bowel series has long been considered the mainstay in the evaluation of the small intestine.83 Data, however, show a relatively low diagnostic yield for patients with occult bleeding or iron deficiency. Although Crohn's disease and large ulcerations of the small intestine are readily diagnosed using this standard examination,21 only approximately 5% of small bowel follow-through examinations detect an intestinal bleeding site. Rabe et al124 reported a diagnostic yield of 5.6% in a series
DIAGNOSTIC AND THERAPEUTIC APPROACH
The extent of evaluation of the patient with obscure bleeding depends on two factors: the extent of the bleeding and the age of the patient. As discussed, the commonest cause of obscure bleeding is angiodysplasia, which accounts for 80% of causes. These patients are typically older than 60 years old. Small bowel tumors are the commonest cause of obscure bleeding in patients younger than age 50. These patients are evaluated differently than older patients. Management decisions in the older group
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2022, International Journal of Biological MacromoleculesCitation Excerpt :The rate of LGIB is increased with advanced age [17]. There are multiple causes of GI bleeding, which includes small bowel lesions, angiodysplasias (vascular ectasia i.e., dilated capillaries), leiomyoma (benign tumors that originate in myometrium), Crohn's diseases, hemangioma (noncancerous growth of birth vessels), infections cause vasculitis, ulceration in the small intestine and small intestine diverticula [18]. Intestinal bleeding associated with perforation is the most severe surgical complication of typhoid enteritis.
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