Analysis The Etiology Of437Cases Of Small Intestinal Hemorrhage

Background:The small intestine is an uncommon source of gastrointestinal hemorrhage. It is reported that small intestinal bleeding occurs in only2%to15%of patients with gastrointestinal bleeding. In general, occult gastrointestinal bleeding (OGIB) is the major manifestation of small intestinal bleeding。Etiology of small intestinal bleeding is various, including vascular abnormalities, tumors, diverticula, and inflammations of the small bowel, etc. It is reported abroad that the commonest cause of small intestinal bleeding is vascular abnormalities accounting for70%to80%, small bowel tumors is the second cause accounting for5%to10%. In contrast, tumors and diverticula are the more frequent causes of small intestine bleeding, whereas vascular lesion is less common in domestic reports.The diagnosis of the small intestinal bleeding may be difficult because Of lacking simple and effective diagnostic imaging procedures. The small intestine is relatively inaccessible to routine endoscopy and the lesions in small intestine may be more likely to be missed or misdiagnosed due to the anatomic characteristics of small intestine such as the organ’s length(about4-6meters), free intraperitoneal location, overlapping of intestinal ansa, active peristalsis, etc. There is a range of diagnostic techniques available for the diagnosis of small intestinal bleeding, including abdominal CT, enteroclysis, radionuclide scans, angiography, capsule endoscopy, double-balloon small bowel endoscopy, exploratory laparotomy, intraoperatire endoscopy, etc. According to reports, different diagnostic methods vary in the diagnostic yield and they were limited in somewhere.Objective:The etiology of small intestinal bleeding was analyzed in order to increase the understanding and identification of small intestinal bleeding. The diagnostic methods used were evaluated so as to seek for the convenient and effective diagnostic methods or processes, improving the ability to diagnose the patients with small intestine bleeding.Methods:437cases of patients with small intestinal bleeding procedures Department of Gastroenterology First Affiliated Hospital, College of Medicine Zhejiang University from July2006to November2010were retrospectively reviewed. Clinical analysis was focused on major symptoms, etiology and different diagnostic methods,Results:In these437case of small intestinal bleeding, there are159cases of vascular lesion and the rate was36%,72cases of inflammatory bowel diseases and the rate was17%,41cases of tumor and the rate was9%,14cases of hookworm disease and the rate was3%,8cases of small intestinal diverticulum and the rate was2%,8cases of allergic purpura and the rate was2%,8cases of others and the rate was2%,127cases of obscure small intestinal hemorrhage diseases and the rate was29%Inflammatory bowel diseases was the main reason due to small intestinal hemorrhage in the young patients and the rate was62%, on the contrary, vascular lesion was the main reason in old patients and the rate was72%. The incidence of vascular lesion grown with the age. On the other hand, there is no different between man and woman, in hospital and outpatient services, long and short course of disease. They have litter help for analysis the etiology of small intestinal hemorrhage282case of tarry stool, which is the commonest form of small intestinal hemorrhage and the rate was65%. Second with109case of bloody stool passage and the rate was29%. Followed by29case of Simple positive fecal occult blood test and17case of unexplained anemia with the rate7%and4%。All cases were received capsule endoscopy examination with302case of positive cues and135case of negative cues, which have8case of negative cues discovered by double-balloon endoscopy examination.The diagnostic rate was69%.153cases were taken contrast CT examination with49case of positive cues and the diagnostic rate was32%.71cases were taken double-balloon endoscopy examination with58cases of positive cues and the diagnostic rate was82%.9cases were taken enteroclysis examination with4cases of positive cues and the diagnostic rate was44%.10cases were taken DSA examination with8cases of positive cues and the diagnostic rate was80%. Only2cases were taken ECT examination with2cases of positive cues and the diagnostic rate was100%.Conclusions:1. The study on437cases of small intestinal bleeding showed that the most common cause is angiodysplasia, followed by inflammatory bowel diseases and tumor. On the other hand, there are some big part of obscure small intestinal hemorrhage diseases that should be respected. Inflammatory bowel diseases was the main reason due to small intestinal hemorrhage in the young patients, on the contrary, vascular lesion was the main reason in old patients. The incidence of vascular lesion grown with the age. There is no different between man and woman, in hospital and outpatient services, long and short course of disease. They have little help for analysis the etiology of small intestinal hemorrhage2. Tarry stool is the commonest form of small intestinal hemorrhage. Followed by bloody stool passage (include solution of dark red blood and red blood) and Simple positive fecal occult blood test and unexplained anemia。In many technique to analysis the etiology of small intestinal hemorrhage, double-contrast enteroclysis and CT was not good enough in identifying small bowel sources of bleeding. Capsule endoscopy is a good diagnosis techniques because of safe and simple and effective. But the pathological diagnosis can’t be obtained. Double-balloon small bowel enteroscopy can directly visualize the small intestine and can get histologiccal diagnosis at the same time. It is still not widely available because of the difficulty to perform and the pain of patient,etc. Although exploratory laparotomy and intraoperative endoscopy are superior diagnostic tools in diagnosis of small intestinal bleeding with a high diagnostic accuracy, they can’t be widely used as routine diagnostic approaches.The small intestinal bleeding is a harmful disease. In order to improve the ability to diagnose the small intestinal bleeding, more attention should be paid to the understanding of it. The most important thing is how to chose properly diagnostic methods for the small intestinal diseases. Our study show that combined with contrast CT, capsule endoscopy and double-balloon endoscopy should become the main diagnosis method to find out the small intestinal hemorrhage. These three methods can complement each other and improve the diagnostic rate.