Filippone Antonella, Cianci Roberta, Milano Angelo, Valeriano Sergio, Di Mizio Veronica, Storto Maria Luigia
Department of Clinical Sciences and Bioimages, Section of Radiological Sciences, G. d'Annunzio University of Chieti, Via dei Vestini, n.5, 66013, Chieti, Italy.
Abdom Imaging. 2008 Jul-Aug;33(4):398-406. doi: 10.1007/s00261-007-9271-8.
Obscure gastrointestinal bleeding is defined as bleeding of unknown origin, that persists or recurs after negative conventional barium contrast studies and upper and lower tract endoscopy. The causes of such a bleeding frequently arise in the small bowel, and they are represented by mucosal vascular abnormalities, neoplasms and other conditions such as Crohn's disease, Meckel's diverticulum, and vasculitis. Conventional barium contrast studies and push enteroscopy allow only a limited small bowel examination; moreover, intraoperative endoscopy may be inconclusive, since the small bowel is difficult to evaluate given its length and tortuous course. In the same way, angiographic diagnosis is stricktly related to the activity rate of hemorrhage. Wireless capsule endoscopy and multidetector-row CT enteroclysis are two recently developed minimally invasive techniques that may provide a complete small bowel examination, the first offering a direct visualization of the mucosal aspect, the second allowing evaluation of mural and extramural pathologies. This review is an update of the technique and clinical application of capsule endoscopy and multidetector-row CT enteroclysis in patients suffering from obscure small bowel bleeding.
不明原因的胃肠道出血定义为来源不明的出血，在传统钡剂造影检查以及上、下消化道内镜检查均为阴性后仍持续或复发。此类出血的原因常发生于小肠，包括黏膜血管异常、肿瘤以及其他疾病，如克罗恩病、梅克尔憩室和血管炎。传统钡剂造影检查和推进式小肠镜检查仅能对小肠进行有限的检查；此外，术中内镜检查可能无法得出明确结论，因为小肠长度较长且走行迂曲，难以评估。同样，血管造影诊断与出血活动率密切相关。无线胶囊内镜和多排探测器CT小肠造影是最近开发的两种微创技术，可对小肠进行全面检查，前者可直接观察黏膜情况，后者可评估肠壁和肠壁外病变。本文综述了胶囊内镜和多排探测器CT小肠造影在不明原因小肠出血患者中的技术及临床应用进展。
