Hsu Wei-Fan, Tsang Yuk-Ming, Teng Chung-Jen, Chung Chen-Shuan
Wei-Fan Hsu, Chung-Jen Teng, Chen-Shuan Chung, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan.
World J Gastroenterol. 2015 Jan 21;21(3):1024-7. doi: 10.3748/wjg.v21.i3.1024.
Obscure gastrointestinal bleeding is an uncommonly encountered and difficult-to-treat clinical problem in gastroenterology, but advancements in endoscopic and radiologic imaging modalities allow for greater accuracy in diagnosing obscure gastrointestinal bleeding. Ectopic varices account for less than 5% of all variceal bleeding cases, and jejunal variceal bleeding due to extrahepatic portal hypertension is rare. We present a 47-year-old man suffering from obscure gastrointestinal bleeding. Computed tomography of the abdomen revealed multiple vascular tufts around the proximal jejunum but no evidence of cirrhosis, and a visible hypodense filling defect suggestive of thrombus was visible in the superior mesenteric vein. Enteroscopy revealed several serpiginous varices in the proximal jejunum. Serologic data disclosed protein C deficiency (33.6%). The patient was successfully treated by therapeutic balloon-assisted enteroscopy and long-term anticoagulant therapy, which is normally contraindicated in patients with gastrointestinal bleeding. Diagnostic modalities for obscure gastrointestinal bleeding, such as capsule endoscopy, computed tomography enterography, magnetic resonance enterography, and enteroscopy, were also reviewed in this article.
隐匿性胃肠道出血是胃肠病学中一种罕见且难以治疗的临床问题，但内镜和放射成像技术的进步使得隐匿性胃肠道出血的诊断准确性更高。异位静脉曲张占所有静脉曲张出血病例的比例不到5%，由肝外门静脉高压引起的空肠静脉曲张出血很少见。我们报告一名47岁患有隐匿性胃肠道出血的男性。腹部计算机断层扫描显示空肠近端周围有多个血管丛，但无肝硬化迹象，肠系膜上静脉可见一个提示血栓的低密度充盈缺损。小肠镜检查发现空肠近端有几条匐行性静脉曲张。血清学数据显示蛋白C缺乏（33.6%）。该患者通过治疗性气囊辅助小肠镜检查和长期抗凝治疗成功治愈，而胃肠道出血患者通常禁忌这种治疗。本文还回顾了隐匿性胃肠道出血的诊断方法，如胶囊内镜、计算机断层扫描小肠造影、磁共振小肠造影和小肠镜检查。
