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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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2019
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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. |
format | Online Article Text |
id | pubmed-6580013 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
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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