Study On The Examination,Treatment And Prognosis Of 121 Cases Of Small Intestinal Hemorrhage

Objective:Small bowel hemorrhage is a rare clinical condition that accounts for approxim-ately 5% to 10% of cases of gastrointestinal bleeding.Due to its insidious onset and lack of specific clinical manifestations,early diagnosis can be difficult.The purpose of this paper is to analyze the clinical data of patients with small bowel hemorrhage,summarize its characteristics,and improve our understanding of the condition.By doing so,we hope to provide ideas for early clinical diagnosis and treatment,ultimately benefiting more patients.Methods:Clinical data of patients with small intestinal bleeding from March 2011 to May 2022 at the Second Affiliated Hospital of Nanchang University were collected for a retrospective study.We investigated the etiology,clinical manifestations,examination methods,and treatment of small intestinal bleeding.Additionally,we used logistic regression methods to analyze the risk factors for requiring surgical intervention and for experiencing recurrent bleeding within 2 yearsResults:Among the 121 patients included in the study,55 were women and 66 were men,with a male-to-female ratio of 1.2:1.The mean age was 55.75(23)years,with ages ranging from 17 to 88 years and disease duration ranging from 3 hours to 10 years.The most common causes of small bowel bleeding were vascular lesions(34.7%),inflammatory lesions(31.4%),and tumors(17.4%),while other causes included diverticula and polyps.Vascular and inflammatory lesions were more common in patients over 60,while inflammatory lesions were more common in those under 40(p<0.05).Clinical manifestations included abdominal pain,dizziness,weakness,and anemia.CT,capsule endoscopy,small bowel microscopy,digital subtraction angiography,and surgical exploration were used for diagnosis,with diagnostic rates of 39.8%,89.4%,78.1%,62.5%,and 93.9%,respectively.The diagnostic rate of capsule endoscopy was higher than that of double balloon small bowel microscopy and CT(p<0.05).Follow-up after discharge revealed 33 cases of recurrent bleeding and 3 deaths within 2 years,with no recurrence in surgical patients.Logistic regression analysis showed that decreased hemoglobin and decreased systolic blood pressure were independent risk factors for surgical intervention,while surgery and hypertension were independent risk factors for recurrent bleeding within 2 years.The blood urea nitrogen to creatinine ratio(BUN/Cr)was found to be a useful diagnostic tool for identifying jejuno-ileal bleeding,with an area under the curve(AUC)of 0.817.The optimal cut-off point for BUN/Cr ratio was 0.085.Conclusion:The etiology of small bowel hemorrhage is most common with vascular and inflammatory lesions;the etiology is age-related and not gender-related.Capsule endoscopy and small bowel microscopy are the most effective diagnostic methods,with high diagnostic rates.Surgical intervention is associated with a good prognosis.The study identifies hemoglobin and systolic blood pressure as independent risk factors for surgical intervention,while surgery and hypertension are independent risk factors for recurrent bleeding within 2 years.Furthermore,the BUN/Cr ratio can guide the choice of small bowel scope access modality.