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. 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

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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

Abstract

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.

Figures

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].

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