Clinical Analysis Of 39 Cases Of Small Intestinal Bleeding

Objective:The clinical manifestations,diagnostic methods and treatment methods of small intestinal bleeding were statistically analyzed,and the common etiology,clinical characteristics and effective diagnosis and treatment methods of intestinal bleeding were discussed to provide theoretical basis for clinical treatment of intestinal hemorrhage.Methods:A retrospective analysis was conducted on the clinical data of 39 patients diagnosed with intestinal bleeding who visited the department of gastrointestinal and colorectal surgery of China-japan friendship hospital of jilin university from July2014 to December 2018.Data collected included general information of patients,clinical manifestations and accompanying symptoms,time of onset,laboratory test results,relevant auxiliary examination results,pathological examination results,treatment methods,etc.SPSS 20.0 was used for all data statistical software for statistical processing.Results:Among the 39 patients with intestinal bleeding,27 were male and 12 were female,the ratio of male to female was 2.25:1.The mean age of onset was 52.1316.39(15 ~ 82)years.The onset time was 15 h ~ 6y,with a median of 5d.The location of intestinal bleeding: jejunum(n = 22),ileum(n = 15),jejunum + ileum(n = 2).Bleeding pattern: dominant bleeding(melena,fresh blood stool)in 38 cases,recessive bleeding(positive in occult test)in 1 case.The main clinical manifestations of intestinal bleeding included 34 cases of anemia(7 cases of mild anemia,23 cases of moderate anemia,4 cases of severe anemia),28 cases of intermittent black stool,and10 cases of fresh blood stool.Main concomitant symptoms: abdominal pain(9 cases),fatigue(9 cases),dizziness(3cases).Relevant examination:(1)Laboratory examination:all the 39 patients underwent blood routine,liver and kidney function,ion,kidney function,coagulation routine,immune routine,urine routine and other laboratory examinations.(2)Imaging examination: abdominal CT examination in 36 cases,abdominal enhanced CT examination in 19 cases,CT angiography(CTA)examination in 4 cases,digital subtraction angiography(DSA)in 2 cases,MRI examination in 2 cases,PET-CT examination in 1 case.(3)Endoscopic examination:gastroscopy in 34 cases,colonoscopy in 34 cases,enteroscopy in 4 cases,and capsule endoscopy in 1 case.(4)Surgical exploration: Laparoscopic exploration was performed in 9 cases,laparotomy in 30 cases,and laparotomy combined with intraoperative positioning(intraoperative colonoscopy and methylene blue)in 3 cases.(5)Thirty-eight of the 39 patients underwent surgical treatment,and pathological examination was performed on all the tissues after surgical resection.The causes of hemorrhage included: small intestinal tumor in 26 cases(stromal tumor in 18 cases,Adenocarcinoma in 3 cases,round cell malignant tumor in 1 case;Sarcomatoid carcinoma in1 case,1 case of lipoma,1 case of schwannoma,T cell lymphoma in 1case);there were 13 cases of non-neoplastic lesions,including 4 cases of intestinal diverticulum,4 cases of vascular lesions,2 cases of inflammatory lesions,2 cases of hamartoma polyps,and 1 case of submucosal pancreatic ectopic position.Treatment methods: all patients were given symptomatic support treatment after admission,followed by conservative treatment in 1 case and surgical treatment in 38 cases(including 3 cases of emergency exploratory laparotomy).Among the 39 patients in this group,6 patients were lost to follow-up,and 33 patients were followed up by telephone or outpatient,with a follow-up rate of 84.62%.Follow-up time was 2-53 months,with a median of 18 months.Among the 33 patients followed up,2 died due to tumor recurrence,1 suffered from recurrent bleeding,1 suffered from intestinal obstruction,and 1 suffered from intermittent abdominal pain.Conclusion:1.Jejunal bleeding is the most common small intestinal bleeding,mainly due toneoplastic lesions of the small intestine,followed by diverticulum,vascular lesions and inflammatory lesions.2.The main clinical manifestations of small intestinal bleeding are anemia and intermittent hematochezia.Chronic dominant bleeding is the main type of small intestinal bleeding.3.Abdominal CT and enhanced CT are common screening methods for small intestinal bleeding,enteroscopy adjuvant examination has a higher diagnostic rate for small intestinal bleeding.4.It is difficult to diagnose the etiology of small intestinal bleeding,and the combination of multiple auxiliary examinations can improve the diagnostic rate.5.The main treatment for small intestinal bleeding is surgery.