Carvalho Rita, Almeida Nuno, Ferreira Manuela, Amaro Pedro, Bernardes António, Cipriano Maria Augusta, Romãozinho J M, Gouveia Hermano, Sofia Carlos
Gastroenterology Department, Coimbra University Hospital, 3000-075 Coimbra, Portugal.
Case Rep Gastrointest Med. 2012;2012:186065. doi: 10.1155/2012/186065. Epub 2012 Sep 19.
Obscure gastrointestinal bleeding is responsible for 2-10% of the cases of digestive bleeding. Angiodysplasia is the most common cause. The authors report a case of a 70-year-old female patient admitted to our Gastrointestinal Intensive Care Unit with a significant digestive bleeding. Standard upper and lower endoscopy showed no abnormalities, and we decided to perform a capsule enteroscopy that revealed a submucosal nodule with active bleeding in the jejunum. An intraoperative enteroscopy confirmed the presence of a small submucosal lesion with a central ulceration, and subsequently a segmental enterectomy was performed. Surprisingly, the histopathological diagnosis was angiodysplasia. The patient remains well after a two-year period of follow-up. We present this case of obscure/overt gastrointestinal bleeding to emphasize the role of capsule and intraoperative enteroscopy in the evaluation of these situations, and because of the unusual endoscopic appearance of the angiodysplasia responsible for the hemorrhage.
隐匿性胃肠道出血占消化道出血病例的2%-10%。血管发育异常是最常见的病因。作者报告了一例70岁女性患者，因严重消化道出血入住我们的胃肠重症监护病房。标准的上消化道和下消化道内镜检查未发现异常，于是我们决定进行胶囊内镜检查，结果显示空肠有一个伴有活动性出血的黏膜下结节。术中内镜检查证实存在一个伴有中央溃疡的小黏膜下病变，随后进行了节段性肠切除术。令人惊讶的是，组织病理学诊断为血管发育异常。经过两年的随访，患者情况良好。我们展示这例隐匿性/显性胃肠道出血病例，以强调胶囊内镜和术中内镜检查在评估这些情况中的作用，以及由于导致出血的血管发育异常内镜表现不寻常。
