Jacobson Tatiana B, Kolade Victor O
Department of Internal Medicine, University of Tennessee, Chattanooga, TN, USA.
Cases J. 2010 Jan 28;3:39. doi: 10.1186/1757-1626-3-39.
A 53 year-old Caucasian man with no previous history of gastrointestinal bleeding presented with sudden, massive hematochezia and abdominal pain; his hemoglobin dropped from 12 to 8.3. Colonoscopy revealed coagulated blood in a diverticulum, but bleeding recurred after cautery of the lesion.Repeated upper and lower gastrointestinal (GI) endoscopy, visceral selective angiogram, bleeding scan, and Meckel diverticulum scan did not locate the source of bleeding. Further investigation with capsule endoscopy demonstrated two arteriovenous malformations in the small bowel.Wireless capsule endoscopy is a sensitive and specific test for overt obscure gastrointestinal bleeding. Clinicians need not hesitate to employ this procedure when other diagnostic modalities fail.
一名53岁的白种男性，既往无胃肠道出血史，突发大量便血和腹痛；血红蛋白从12降至8.3。结肠镜检查显示一个憩室内有凝血块，但病变烧灼后出血复发。反复进行上、下消化道内镜检查、内脏选择性血管造影、出血扫描及美克尔憩室扫描均未找到出血源。进一步行胶囊内镜检查发现小肠有两处动静脉畸形。无线胶囊内镜对明显的隐匿性胃肠道出血是一种敏感且特异的检查方法。当其他诊断方法失败时，临床医生应毫不犹豫地采用这一检查。
