The Investigation Of Etiologies And Diagnostic Methods Of Small Intestinal Bleeding

[Background and objective] Small intestinal usually refers to the intestinal bleeding between Treitz ligament and ileocecal valve. Small intestinal bleeding is relatively rare among the digestive tract hemorrhage. Small intestinal bleeding accounts about 2%-15% of the entire gastrointestinal bleeding. As the small intestine is far from the mouth and anus, and the small intestine is longer, greater activity. The value of conventional gastric endoscopy and colonoscopy in the diagnosis of small intestinal bleeding is limited. The clinical diagnosis of patients with small intestinal bleeding is very difficult. Through the analysis of 43 cases diagnosed small intestinal bleeding in Qilu Hospital of Shandong University, To investigate the etiology and diagnosis of small intestinal bleeding.[Methods] All the 43 patients were diagnosed small intestinal bleeding from 2004 to 2009 in Qilu Hospital of Shandong University. All of them were analyzed according to etiologies and diagnosises. Most of the patients had been excluded upper gastrointestinal bleeding and colorectal bleeding through the upper and lower gastrointestinal endoscopy. And then find out the bleeding site through one or more diagnostic methods of barium meal examination of gastrointestinal tract, ECT, DSA, capsule endoscopy, enteroscopy, and laparotomy. The etiologies of all the patients had been confirmed by surgery and pathology. The main diagnostic methods include gastroendoscopy, colonoscopy, capsule endoscopy, enteroscopy, barium meal examination of gastrointestinal tract and DSA. [Results] Among 43 cases with small intestinal bleeding, small intestinal tumors 21 cases(48.8%), benign tumors 5 cases, malignant tumors 16 cases, small intestinal diverticulum 7 cases (16.3%), small intestinal vascular malformation 4 cases (9.3%), small intestinal polyp 4 cases (9.3%), Crohn disease 2 cases (4.7%), small intestinal ulcer 2 cases (4.7%), small intestinal intussusception 1 case (2.3%), small intestinal rupture 1 case (2.3%), small intestinal tuberculosis 1 case(2.3%). The positive rate of the barium meal examination of all gastrointestinal tract is 14.3%(3/21), ECT 33.3%(2/6), DSA 40.0%(6/15), capsule endoscopy 76.0%(19/25), enteroscopy 86.7%(13/15).[Conclusions] Tumor was the most common disease which led to small intestinal bleeding, and the most common tumor was SIST. Among non-neoplastic causes, small intestinal diverticulum was the most common disease, followed by small intestinal vascular malformation. Among diagnostic methods, the value of enteroscopy and capsule endoscopy was greatest for the diagnosis of small intestinal bleeding. ECT, DSA, and the barium meal examination of all gastrointestinal tract were helpful for the diagnosis of small intestinal bleeding.