Rieder F, Schneidewind A, Bolder U, Zorger N, Schölmerich J, Schäffler A, Gölder S, Kullmann F, Herfarth H
Department of Internal Medicine I, University of Regensburg, Regensburg, Germany.
Endoscopy. 2006 May;38(5):526-8. doi: 10.1055/s-2006-925002.
Detecting the source of obscure gastrointestinal bleeding can be difficult. Capsule endoscopy is a promising diagnostic tool for investigating patients with this condition, although identifying the source of intermittent or low-grade bleeding remains a diagnostic challenge. We present case reports of two patients with obscure gastrointestinal bleeding, in whom the source of recurrent bleeding episodes was diagnosed by capsule endoscopy while they were on anticoagulation therapy. The first patient, an 81-year-old white woman, was on long-term oral anticoagulation because she had chronic atrial fibrillation. Capsule endoscopy demonstrated a bleeding tumor in the region of the terminal ileum. The second patient, a 59-year-old white man, underwent an initial capsule endoscopy, which was negative. After initiation of anticoagulation with heparin, a second capsule endoscopy procedure in this patient revealed several small bleeding lesions in the proximal small bowel. In both cases a gastrointestinal stromal tumor was identified as the bleeding source and was resected. These two cases demonstrate that provocation of bleeding during capsule endoscopy may increase its sensitivity.
检测隐匿性胃肠道出血的来源可能具有挑战性。胶囊内镜检查是用于调查患有这种情况的患者的一种有前景的诊断工具，尽管识别间歇性或轻度出血的来源仍然是一项诊断挑战。我们报告了两例隐匿性胃肠道出血患者的病例，在他们接受抗凝治疗期间，通过胶囊内镜检查诊断出反复出血发作的来源。第一例患者是一名81岁的白人女性，因患有慢性心房颤动而接受长期口服抗凝治疗。胶囊内镜检查显示回肠末端区域有一个出血性肿瘤。第二例患者是一名59岁的白人男性，最初的胶囊内镜检查结果为阴性。在用肝素开始抗凝治疗后，该患者的第二次胶囊内镜检查发现小肠近端有几个小的出血性病变。在这两个病例中，胃肠道间质瘤被确定为出血源并进行了切除。这两个病例表明，胶囊内镜检查期间诱发出血可能会提高其敏感性。
