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Obscure gastrointestinal bleeding resulting from small bowel neoplasia; A case series

INTRODUCTION: Undiagnosed gastrointestinal bleeding may originate in the small bowel. This presents a diagnostic challenge despite the advancement in contemporary imaging. We report two cases which highlight the limitations of routine investigation for obscure gastrointestinal bleeding. PRESENTATION...

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Autores principales: Teh, Jia Wei, Fowler, Amy L., Donlon, Noel E., Khan, Waqar, Khan, Iqbal Z., Waldron, Michael, Barry, Kevin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580013/
https://www.ncbi.nlm.nih.gov/pubmed/31207533
http://dx.doi.org/10.1016/j.ijscr.2019.05.006
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author Teh, Jia Wei
Fowler, Amy L.
Donlon, Noel E.
Khan, Waqar
Khan, Iqbal Z.
Waldron, Michael
Barry, Kevin
author_facet Teh, Jia Wei
Fowler, Amy L.
Donlon, Noel E.
Khan, Waqar
Khan, Iqbal Z.
Waldron, Michael
Barry, Kevin
author_sort Teh, Jia Wei
collection PubMed
description INTRODUCTION: Undiagnosed gastrointestinal bleeding may originate in the small bowel. This presents a diagnostic challenge despite the advancement in contemporary imaging. We report two cases which highlight the limitations of routine investigation for obscure gastrointestinal bleeding. PRESENTATION OF CASE: Patient A presented with a history of rectal bleeding, treated with interventional embolisation of caecal angiodysplasia. A diagnosis of neuroendocrine tumour (NET) was reached two years after presentation following intraoperative right hemicolectomy resection of a presumed recurrent angiodysplastic bleed. Patient B presented with recurrent melaena labelled as non-steroidal anti-inflammatory drug (NSAID) induced gastritis. After multiple endoscopic and radiological investigations, a 4.5 cm mass was visualised on imaging after three years, which was histologically proven as gastrointestinal stromal tumour (GIST) of the small bowel. Both patients experienced a delayed diagnosis despite multiple investigations and careful follow-up. DISCUSSION: Our case series discusses the benefits and limitations of investigation for gastrointestinal bleeding and suggests a need for continued multidisciplinary input in situations where the patient presumed diagnosis remains in question. CONCLUSION: OGIB remains a diagnostic challenge and is attributable to small bowel pathology in 75% of cases. This suggests a need for continued investigation in situations where the patient presents multiple times despite adequate treatment for the presumed underlying condition.
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spelling pubmed-65800132019-08-20 Obscure gastrointestinal bleeding resulting from small bowel neoplasia; A case series Teh, Jia Wei Fowler, Amy L. Donlon, Noel E. Khan, Waqar Khan, Iqbal Z. Waldron, Michael Barry, Kevin Int J Surg Case Rep Article INTRODUCTION: Undiagnosed gastrointestinal bleeding may originate in the small bowel. This presents a diagnostic challenge despite the advancement in contemporary imaging. We report two cases which highlight the limitations of routine investigation for obscure gastrointestinal bleeding. PRESENTATION OF CASE: Patient A presented with a history of rectal bleeding, treated with interventional embolisation of caecal angiodysplasia. A diagnosis of neuroendocrine tumour (NET) was reached two years after presentation following intraoperative right hemicolectomy resection of a presumed recurrent angiodysplastic bleed. Patient B presented with recurrent melaena labelled as non-steroidal anti-inflammatory drug (NSAID) induced gastritis. After multiple endoscopic and radiological investigations, a 4.5 cm mass was visualised on imaging after three years, which was histologically proven as gastrointestinal stromal tumour (GIST) of the small bowel. Both patients experienced a delayed diagnosis despite multiple investigations and careful follow-up. DISCUSSION: Our case series discusses the benefits and limitations of investigation for gastrointestinal bleeding and suggests a need for continued multidisciplinary input in situations where the patient presumed diagnosis remains in question. CONCLUSION: OGIB remains a diagnostic challenge and is attributable to small bowel pathology in 75% of cases. This suggests a need for continued investigation in situations where the patient presents multiple times despite adequate treatment for the presumed underlying condition. Elsevier 2019-05-10 /pmc/articles/PMC6580013/ /pubmed/31207533 http://dx.doi.org/10.1016/j.ijscr.2019.05.006 Text en © 2019 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Teh, Jia Wei
Fowler, Amy L.
Donlon, Noel E.
Khan, Waqar
Khan, Iqbal Z.
Waldron, Michael
Barry, Kevin
Obscure gastrointestinal bleeding resulting from small bowel neoplasia; A case series
title Obscure gastrointestinal bleeding resulting from small bowel neoplasia; A case series
title_full Obscure gastrointestinal bleeding resulting from small bowel neoplasia; A case series
title_fullStr Obscure gastrointestinal bleeding resulting from small bowel neoplasia; A case series
title_full_unstemmed Obscure gastrointestinal bleeding resulting from small bowel neoplasia; A case series
title_short Obscure gastrointestinal bleeding resulting from small bowel neoplasia; A case series
title_sort obscure gastrointestinal bleeding resulting from small bowel neoplasia; a case series
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580013/
https://www.ncbi.nlm.nih.gov/pubmed/31207533
http://dx.doi.org/10.1016/j.ijscr.2019.05.006
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