Jejunoileal causes of overt gastrointestinal bleeding: Diagnosis, management, and outcome

Major bleeding from the small intestine is uncommon and difficult to locali ze. We examined its etiologies and assessed available diagnostic and therap eutic approaches. The records of all adults undergoing operation for small intestinal hemorrhage over a 10-year period (1/89-12/98) were reviewed. The re were eight men and four women with a mean age of 54 years. Six patients presented with arteriovenous malformations. Preoperative diagnosis was by e ndoscopy (three of six), scintigraphy (two of two), and/or angiography (two of six). Intraoperative panendoscopy was used for localization in 5 cases. Three other patients had tumors (leiomyoma, leiomyosarcoma, and adenocarci noma) by CT scan (two) and/or scintigraphy (two). All were resected but one patient died of recurrence. Two patients underwent resection of a Meckel's diverticulum, one after angiographic diagnosis. Another patient with Croon 's disease had a positive angiogram and colonoscopy before resection. There were no operative deaths but major morbidity occurred in five patients (42 %) and hospitalization averaged 17 days. We conclude that jejunoileal lesio ns are a rare cause of intestinal bleeding but can be associated with subst antial morbidity. Arteriovenous malformations and tumors remain the most co mmon causes. An accurate diagnosis and definitive management depend on sele ctive preoperative imaging and judicious operative exploration.