22.dr suhas murali.cdr


INTRODUCTION :  
Obscure GI bleed is a condition when there is denitive 
Gastro-Intestinal(GI) bleed, whose source remains elusive 
despite an initial negative Upper-GI endoscopy and a 

1colonoscopy . Occult GI bleed can occur anywhere in the GI 
tract. But the diagnosis becomes extremely tricky when 
endoscopic reports are negative for gross bleeds. The newer 
diagnostic modalities like Capsule Endoscopy (CE ) thus 
perfectly t into this vacuum of diagnostic modalities. We 
report one such case diagnosed by Capsule Endoscopy.

CASE REPORT : 
A 52 year old otherwise healthy female patient presented to 
the casualty with complaints of generalized weakness & easy 
fatigability since 1 month. There was no history of any 
bleeding tendencies. Routine investigations showed a severe 
anemia of 6.7g/dl Hemoglobin. Stool for occult blood was 
positive. This prompted us to focus on the GI tract for the 
source of the bleeder. She later underwent an upper GI-
endoscopy which was normal. A colonoscopy also showed a 
normal study. Then suspecting the source of the bleed to be 

rdbetween the duodenum 3  part and the ileo-caecal junction, 
the patient was subjected for a capsule endoscopy (CE) 
examination. This showed multiple bleeding spots in the 
jejunum which were actively bleeding. The patient was then 
posted for surgery, when she underwent a short segment 
resection anastomosis of the jejunum. 

Figure -1 : The picture shows the capsule endoscopy sho 
wing active bleeding from the jejunum.

On histopathological examination of the resected sample, it 
showed congested mucosa with lamina propria showing 
numerous ectatic blood vessels of varying sizes suggestive of 
vascular ectasias.

RESULTS : 
Post-operatively the patient showed remarkable improvement 
with no sequele and was discharged 10 days later from 
hospital.

DISCUSSION : 
Gastro-Intestinal bleeds that occur as a result of bleeders in 
between the Ligament of Treitz and the Ileo-Caecal valve; in 
other words between that part of the Gastro-intestinal tract not 
visualized by the routine Upper-GI scopy and colonoscopy 

2accounts for approximately 5% of gastro-intestinal bleeding . 
Amongst the most common causes bleeding from this region 
includes angiectasias which accounts for 30-40% amongst 

3these; specially in elderly . Other important causes of occult 
GI bleeds from the small bowel includes NSAID induced 
enteropathy, IBD with ulcers or erosions, tumours, radiation 
enteropathy, Dieulafoy's lesions & small bowel varices. The 
location of these lesions make it extremely tricky to diagnose.
The capsule endoscope however lets us have a visualization 
of the entire small intestine. 

Compared to intraoperative enteroscopy , Capsule Endo 
scopy had a sensitivity of 95% and specicity of 75% in a 

4prospective of 47 patients in.  

Comapred to  CT angiography and standard angiography, 
Capsule Endoscopy detected more bleeding source lesions 

5(72% with VCE vs 24% with CTA and 56% with angiography).
Benets of capsule endoscopy include its non-invasive nature, 
better patient compliance and safety. 

But drawbacks include inability as a therapeutic intervention, 
many false positive results and chances of erratic passage 
causing missed lesions.

If signicant lesions like the one discovered in our patient is 
detected, the patient is referred for specic management of the 
cause. If the initial capsule endoscopy is negative one more 
attempt maybe done. If the second capsule endoscopy is also 
negative then the patient maybe managed conservatively.

CONCLUSION : 
The main objective of this case report was to highlight the role 
of capsule endoscopy in reaching and identifying occult 
bleeding points which were till recently inaccessible. Even 
though capsule endoscopy lacks the therapeutic intervention 
needed, it can direct the physician on further course of 
management.

Hence we suggest that Capsule endoscopy as the rst investi 
gation of choice for evaluation of small bowel in patients with 
occult gastro-intestinal bleeds.

REFERENCES :
1.  Thomas J.S, Dennis M.J. Sleisenger and Fordtran’s Gastrointestinal and Liver 

Diseases 9th,19:285
2.  Katz LB. The role of surgery in occult gastrointestinal bleeding. Semin 

Gastrointest Dis 1999;10:78-81.
3.  Foutch PG. Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol 

1993;88:807-18.
4.  Hartmann D, Schmidt H, Bolz G, et al. A prospective two-center study 

comparing wireless capsule endoscopy with intraoperative enteroscopy in 
patients with obscure GI bleeding. Gastrointest Endosc 2005; 61:826-32.

5.  Saperas E, Dot J, Videla S, et al. Capsule endoscopy versus computed 
tomographic or standard angiography for the diagnosis of obscure 
gastrointestinal bleeding. Am J Gastroenterol 2007;102:731-7.

A CASE REPORT OF VASCULAR ECTASIAS OF GI TRACT PRESENTING AS 
OCCULT GASTRO-INTESTINAL BLEED DIAGNOSED ON CAPSULE 

ENDOSCOPY

Original Research Paper

Dr. Santosh Hajare
Professor, Department Of Gastroenterology, J.n.medical College, Kle 
University, Belagavi

  X 7GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS

Gastroenterology

KEYWORDS : 

VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

Dr. Suhas. Murali*
Resident In General Medicine, J.N. Medical College, KLE University, Belagavi
*Corresponding Author