small intestinal hemorrhage

Pathology

• GI bleeding between the ampulla of Vater & the ileocecal valve

Clinical manifestations

• overt or occult GI bleeding
• anemia

Diagnostic procedures

• capsule endoscopy* (after repeat upper GI endoscopy & colonoscopy) for diagnosis
• push enteroscopy for treatment
• balloon enteroscopy mentioned

* avoid capsule endoscopy if intestinal obstruction or intestinal strictures (advanced Crohn's disease)

Radiology

• CT angiography (CTA) for hemodynamically unstable patients
• angiography allows localization & embolization of bleeding source in actively bleeding patients
  • requires bleeding rate > 0.5 mL/hour
• CT enterography utilizes oral and intravenous contrast
  • instead of CTA in hemodynamically stable patients with suspected ongoing small bowel bleeding after negative colonoscopy, EGD, & capsule endoscopy
• first-line imaging in patients at excess risk for video capsule retention (e.g., strictures, radiation) or with suspected small bowel neoplasm

More general terms

• upper gastrointestinal hemorrhage