Cummings Clinton L
Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA.
J Natl Med Assoc. 2004 Dec;96(12):1653-6.
This case illustrates the importance of early capsule endoscopy in cases of severe rectal bleeding when initial diagnostic tests do not document the site of bleeding. Although this case occurred in a community hospital capable of performing capsule endoscopy, I practice at a city hospital that serves the poor and underserved and currently does not have capsule endoscopy capability. Over the years, we have seen several cases of severe rectal bleeding where the site of bleeding was never identified, despite multiple diagnostic procedures short of capsule endoscopy. Often times, the bleeding stops spontaneously or ends in emergency surgery where morbidity or mortality is increased. Physicians like myself need to be made aware of this relatively new diagnostic tool that provides added value to standard diagnostic tests for evaluating severe rectal bleeding of unknown etiology. Early identification of the site of rectal bleeding may curtail the need for multiple transfusions, resolve economical burden, and reduce morbidity and mortality associated with severe rectal bleeding.
本病例说明了在严重直肠出血且初始诊断检查未明确出血部位时，早期进行胶囊内镜检查的重要性。尽管该病例发生在一家具备胶囊内镜检查能力的社区医院，但我工作的城市医院服务于贫困和医疗服务不足的人群，目前尚不具备胶囊内镜检查能力。多年来，我们见过几例严重直肠出血病例，尽管进行了除胶囊内镜检查之外的多项诊断程序，但出血部位仍未明确。通常，出血会自行停止，或者以增加发病率或死亡率的急诊手术告终。像我这样的医生需要了解这种相对较新的诊断工具，它能为评估病因不明的严重直肠出血的标准诊断测试提供附加价值。早期识别直肠出血部位可能会减少多次输血的需求，解决经济负担，并降低与严重直肠出血相关的发病率和死亡率。
