Clinical Features of Obscure-Overt Gastrointestinal Bleeding

Kim, Jong Pyo; Han, Dong Soo; Lee, Hang Lak; Kim, Jin Bae; Park, Joon Yong; Eun, Chang Soo; Lee, Oh Yong; Sohn, Joo Hyun; Choi, Ho Soon; Hahm, Joon Soo

Abstract

BACKGROUND/AIMS: Obscure gastrointestinal bleeding (OGIB) is defined as recurrent acute or chronic bleeding for which no sources have been identified by routine endoscopic and contrast studies. The patients with OGIB are frequently difficult to manage and often undergo extensive investigation and even laparatomy without diagnosis. The aim of this study was to review our overall experiences of the investigation and treatment of OGIB. METHODS: We reviewed, retrospectively, medical records of 41 cases with OGIB from June 1996 to July 2002. RESULTS: Of the 41 patients with OGIB, there were 21 men and 20 women and their mean age was 47.8 years (range, 18 to 81 years). Diagnosis was possible in 13 patients (31.7%) and no specific causes were identified in the remaining 28 patients (68.3%). The principal etiologies were gastrointestinal stromal tumor of the small bowel in 3 cases, duodenal diverticulum in 2 cases. Other causes are as follows: adenocarcinoma of the duodenal 3rd portion, duodenal varix at the 4th portion, splenic artery pseudoaneurysm, Crohn's disease, jejunal ulcer, ileal ulcer, ileal angiodysplasia, and anastomosis site bleeding after hemicolectomy. CONCLUSIONS: We conclude that further and logical diagnostic investigations such as small bowel enteroscopy and wireless capsule endoscopy will promise better results.