Purpose: Obscure intestinal bleeding is generally defined as recurrent acute or chronic bleeding for which no source have been identified by routine radiologic and endoscopic examination. Recently a capsule containing video record device has developed and clinically applied to diagnose variable range of small bowel disease including small bowel bleeding. The aim of this study was to report the early experience of small bowel bleeding detected by capsule endoscopy and the results of laparoscopy assisted operation for obscure intestinal bleeding.
Methods: Eleven patients was operated for obscure intestinal bleeding and the bleeding focus was detected by capsule endoscopy before operation. Laparoscopy assisted operations were performed and we carried out intra-operative enteroscopy to find the bleeding focus.
Results: Of the 11 patients, 2 cases of Crohn´s disease, 2 cases of angiodysplasia, one case of tuberculosis enteritis, capillary hemagioma, Meckel´s diverticulum, GIST (gastrointestinal stromal tumor), lymphoma, and submucosal hemorrhage were detected respectively. Other one case had cavernous hemangioma and heterotropic pancreas simultaneously. Laparoscopic localization of the lesion was only in 3 cases with Meckel´s diverticulum, GIST and lymphoma. 3 cases without the natural passage of capsule endoscopy was identifed the lesion with small bowel exploration by the palpation. Intra-operative enteroscopy was performed in 5 case for localization of the lesion. None of patients has not recurred from the gastrointestinal bleeding during follow-up (mean 10.6 months) after the operation.
Conclusion: Intra-operative enteroscopy is mandatory procedure for localization of identified the lesions with bleeding by preoperative capsule endoscopy. And laparoscopy assisted operation is able to explore the intra-abdominal cavity, to identify some lesions and adequate mini-laparotomy.
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