Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019;60:87-90.
doi: 10.1016/j.ijscr.2019.05.006. Epub 2019 May 10.

Obscure Gastrointestinal Bleeding Resulting From Small Bowel Neoplasia; A Case Series

Free PMC article

Obscure Gastrointestinal Bleeding Resulting From Small Bowel Neoplasia; A Case Series

Jia Wei Teh et al. Int J Surg Case Rep. .
Free PMC 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.

Keywords: Case report; Gastrointestinal stromal tumour; Neuroendocrine tumour; Obscure gastrointestinal bleeding; Small bowel.


Fig. 1
Fig. 1
Coronal view of CT AP showing 4.5 cm lobulated mass in the anterior abdominal wall.
Fig. 2
Fig. 2
Sagittal view of CT AP showing 4.5 cm lobulated mass in the anterior abdominal wall.
Fig. 3
Fig. 3
Sequence of investigation of OGIB in accordance to the ACG clinical guideline [2].

Similar articles

See all similar articles

Cited by 1 article


    1. Shepherd N.A., Valori R.M. The effective use of gastrointestinal histopathology: guidance for endoscopic biopsy in the gastrointestinal tract. Frontline Gastroenterol. 2014;5:84–87. - PMC - PubMed
    1. Gerson L.B., Fidler J.L., Cave D.R., Leighton J.A. ACG clinical guideline: diagnosis and management of small bowel bleeding. Am. J. Gastroenterol. 2015;110:1265–1287. - PubMed
    1. Agha R.A., Borrelli M.R., Farwana R., Koshy K., Fowler A., Orgill D.P., SCARE Group The PROCESS 2018 statement: updating consensus preferred reporting of CasE series in surgery (PROCESS) guidelines. Int. J. Surg. 2018;(60):279–282. - PubMed
    1. Gurudu S.R., Bruining D.H., Acosta R.D., Eloubeidi M.A., Faulx A.L., Khashab M.A., Kothari S., Lightdale J.R., Raman Muthusamy V., Yang J., Dewitt J.M. The role of endoscopy in the management of suspected small-bowel bleeding. Gastrointest. Endosc. 2017;85:22–31. - PubMed
    1. Tee H.-P., Kaffes A.J. Non-small-bowel lesions encountered during double-balloon enteroscopy performed for obscure gastrointestinal bleeding. World J. Gastroenterol. 2010;16:1885–1889. - PMC - PubMed