Analysis Of Causes And Clinical Diagnosis Of Small Intestinal Bleeding

Objective To discuss about the causes of small intestinal bleeding and the use ofdifferent diagnostic methods in small intestinal bleeding.Methods From September2006to November2011,totally67cases of small intestinalbleeding were admitted in Union Hospital affiliated to Fujian Medical University andin the First Affiliated Hospital of Fujian Medical University.The causes were analyzedretrospectively and the positive rate and value of diagnostic methods were compared.Results Tumors accounted for38.8%of the patients,followed by inflammation32.8%,vascular disease13.4%,diverticulum10.5%,hookworm3.0%and polyp1.5%.The positive rate of laparotomy combined with intraoperative endoscopy was100.0%,followed by laparoscopy83.3%,laparotomy75.9%,capsule endoscopy(CE)73.7%,do-uble-balloon endoscopy(DBE)66.7%,emissions-computer-tomographie(ECT)63.6%,diaital subtraction angiography(DSA)57.1%,gastrointestinal barium meal radiograph-y36.4%and colonoscopy23.9%.Different diagnostic methods had differences inpositive rate of different causes of small intestinal bleeding.And different diagnosticmethods also had differences in diagnostic value of different forms of small intestinalbleeding:when it was acute massive bleeding,laparotomy combined with intraoperati-ve endoscopy,laparotomy,DBE and DSA had higher diagnostic value;when it waschronic overt bleeding,CE and ECT had higher diagnostic value;while when it waschronic negative bleeding,gastrointestinal barium meal radiography had higherdiagnostic value.The blood urea nitrogen/creatinine ratio(BUN/Cr) of upper jejunumbleeding was higher than that of lower ileum bleeding.The receiver operatingcharacteristic(ROC) area under curve(AUC) of BUN/Cr to distinguish upper jejunumbleeding and lower ileum bleeding was0.715,and the correct diagnosis index ofBUN/Cr equaled to8.500as the cut-off point was0.655.Conclusions Tumors,inflammation and vascular disease were the common causes ofsmall intestinal bleeding.CE and DBE were the relatively ideal methods for diagnosis of small intestinal bleeding.Select the appropriate diagnostic methods according to thespecific circumstances of the form of small intestinal bleeding and BUN/Cr couldimprove the positive rate of small intestinal bleeding effectively.