Small Bowel Bleeding

GI bleeding can happen at any part of the gastrointestinal tract. Bleeding in the small bowel is rare (accounts only 5% of all GI bleeding) but can be problematic since the small bowel is long, thin, and difficult to access. There are no specific signs for small bowel bleeding. Blood test usually shows anemia. Patient may have signs of anemia, such as paleness, fatigue, dizziness, feeling unwell, etc. Patient can have normal stools with positive fecal occult blood test, dark stools, melena, maroon colored stools, or fresh rectal bleeding, etc.

Causes and risks of small bowel bleeding

Common causes are:

  • Angioectasias or arteriovenous malformations (AVMs)
  • Tumors
  • Meckel’s diverticuli
  • Polyps
  • Crohn’s disease
  • NSAIDS induced mucosal injury
  • Vasculitis
  • Aortoenteric fistula
  • Blue rubber bleb nevus syndrome
  • Amyloidosis
  • Radiation-induced mucosal damage
  • Hemangioma

Common risk factors are:

  • NSAIDS
  • ASA
  • Antiplatelet agents, such as Plavix
  • Anticoagulation agents, such as Coumadin
  • Coagulopathy
  • Vit K deficiency
  • Chronic renal failure
  • Low platelet
  • Blood transfusion

Diagnosis and Treatment

Endoscopy is both a diagnostic and treatment procedure, which plays an important role in management of small bowel bleeding. This includes EGD, enteroscopy, push enteroscopy, capsule endoscopy, double balloon enteroscopy, etc.

Bleeding that cannot be found with endoscopy is called obscure bleeding. In order to find the source of bleeding, repeat the endoscopy or use other procedures, such as radionuclide scanning, angiography, exploratory laparotomy, etc, will be considered.

For advanced learning of small bowel bleeding, click here.

References:

  1. PubMed Health.
  2. Wikipedia.
  3. Mayo clinic online health information.
  4. Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
  5. The Little Black Book of Gastroenterology-by David W. Hay.
  6. Principles of Clinical Gastroenterology by Tadataka Yamada, et al.


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