GASTROINTESTINAL-BLEEDING OF OBSCURE ORIG IN - REPORT OF 31 CASES

Thirty one patients with GI bleeding of obscure origin, defined as tho se with normal upper endoscopy and colonoscopy, were studied to know t he yield of different diagnostic procedures. Seventeen patients consul ted for hematochezia and bleeding less than 10 days of evolution in 71 %. Small bowel X ray examination was performed in 14 cases with a diag nostic effectiveness (number of diagnosis/number or examination) of 14 %, angiography was performed in 12 cases with an effectiveness 33%, ra diolabeled erythrocyte scanning in 12 cases with an effectiveness of 7 5%, scintigraphy with pertechnetate in 6 cases with an effectiveness o f 17% and intraoperatory endoscopy in 2 cases with an effectiveness of 50%. A definitive diagnosis was reached in 8 patients during the firs t admission and in 6 during the second admission. The principal etiolo gies were small bowel tumors in 3 cases, cecal ulcers in 2 and ileal d iverticula in 2. Ten subjects were subjected to surgical and 2 to endo scopic treatment. Five patients with recurrent bleeding remain without diagnosis. It is concluded the radiolabeled erithrocyte scanning and angiography are effective examinations that should follow upper and lo wer endoscopies in the diagnosis of a concealed GI bleeding. When a di agnosis is not reached in the first admission, patients should be foll owing with repeated diagnostic procedures.