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small intestinal hemorrhage
Pathology:
- GI bleeding between the ampulla of Vater & the ileocecal valve
Clinical manifestations:
- overt or occult GI bleeding
- anemia
Special laboratory:
- capsule endoscopy* (after repeat upper GI endoscopy & colonoscopy) for diagnosis
- push enteroscopy for treatment
- balloon enteroscopy mentioned
* avoid capsule endoscopy if intestinal obstruction or intestinal strictures (advanced Crohn's disease)
Radiology:
- CT angiography (CTA) for hemodynamically unstable patients
- angiography allows localization & embolization of bleeding source in actively bleeding patients
- requires bleeding rate > 0.5 mL/hour
- CT enterography utilizes oral and intravenous contrast
- instead of CTA in hemodynamically stable patients with suspected ongoing small bowel bleeding after negative colonoscopy, EGD, & capsule endoscopy [3]
- first-line imaging in patients at excess risk for video capsule retention (e.g., strictures, radiation) or with suspected small bowel neoplasm
General
upper gastrointestinal hemorrhage
References
- Medical Knowledge Self Assessment Program (MKSAP) 17, 18.
American College of Physicians, Philadelphia 2015, 2018.
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022
- Gerson LB, Fidler JL, Cave DR, Leighton JA.
ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.
Am J Gastroenterol. 2015 Sep;110(9):1265-87;
PMID: 26303132
- Sengupta N et al.
The role of imaging for gastrointestinal bleeding: Consensus recommendations from
the American College of Gastroenterology and Society of Abdominal Radiology.
Am J Gastroenterol 2024 Mar; 119:438.
PMID: 38857483
https://journals.lww.com/ajg/fulltext/2024/03000/the_role_of_imaging_for_gastrointestinal_bleeding_.15.aspx
- Sengupta N, Kastenberg DM, Bruining DH et al
The Role of Imaging for GI Bleeding: ACG and SAR Consensus Recommendations.
Radiology. 2024 Mar;310(3):e232298.
PMID: 38441091 Review.