Zhang JuDong, Hsieh YiFang, Xu Jing
Department of Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Tianjin, CHN.
School of Medicine, Nankai University, Tianjin, CHN.
Cureus. 2025 May 16;17(5):e84251. doi: 10.7759/cureus.84251. eCollection 2025 May.
Obscure gastrointestinal bleeding (OGIB) is characterized by persistent or recurrent bleeding without a clear source despite standard endoscopic and radiographic investigation. Acute, severe OGIB presents a significant therapeutic challenge, particularly when hemodynamic instability precludes invasive diagnostic procedures. A 74-year-old Asian man presented with acute, severe OGIB and massive hematochezia. Initial laboratory tests revealed severe anemia (hemoglobin 31 g/L) and hypofibrinogenemia (0.95 g/L). Despite negative findings on gastroscopy, colonoscopy, abdominal CT, and angiography, and despite aggressive resuscitation with fluids, blood products, and hemostatic agents, bleeding persisted. A long tube was placed under fluoroscopic guidance, and bloody aspirate confirmed its distal jejunal position. Localized administration of thrombin and Yunnan Baiyao via the long tube achieved hemostasis within 24 hours, and the patient's hemoglobin stabilized. He was discharged after 10 days. This case demonstrates the successful use of long tube-directed hemostatic therapy in acute, severe OGIB when conventional methods are inconclusive and further diagnostic evaluation is limited by the patient's clinical condition. This approach may represent a valuable alternative for achieving hemostasis and bridging patients to definitive therapy. Further research is warranted to confirm the efficacy and safety of this technique.
不明原因胃肠道出血（OGIB）的特征是尽管进行了标准的内镜和影像学检查，但仍存在持续或反复出血且出血源不明。急性、严重的OGIB带来了重大的治疗挑战，尤其是当血流动力学不稳定排除了侵入性诊断程序时。一名74岁的亚洲男性出现急性、严重的OGIB并伴有大量便血。初步实验室检查显示严重贫血（血红蛋白31g/L）和低纤维蛋白原血症（0.95g/L）。尽管胃镜、结肠镜、腹部CT和血管造影检查结果均为阴性，且积极进行了液体、血液制品和止血剂复苏，但出血仍持续。在透视引导下放置了一根长管，血性抽吸物证实其位于空肠远端。通过长管局部注射凝血酶和云南白药在24小时内实现了止血，患者的血红蛋白稳定。10天后患者出院。该病例表明，当传统方法无定论且进一步的诊断评估受患者临床状况限制时，长管引导下的止血治疗在急性、严重OGIB中成功应用。这种方法可能是实现止血并使患者过渡到确定性治疗的一种有价值的替代方法。有必要进行进一步研究以证实该技术的有效性和安全性。
