Enteroscopic Management of Life-Threatening Obscure Gastrointestinal Bleeding Due to Jejunal Leiomyoma
Dhaval Choksi*, Ketaki Choksi, Vidya Kale and Milind Shah
Abstract
Obscure gastrointestinal bleeding is a difficult medical emergency to manage. Benign small bowel tumors are rare cause of obscure gastrointestinal bleeding. A case of jejunal polyp measuring 3x2 cms, is presented which was diagnosed by advanced endoscopic technique of capsule endoscopy and push enteroscopy. The patient had severe comorbid conditions like Diabetes Mellitus, Hypertension, Ischemic Heart Disease with cardiomyopathy (Ejection Fraction-30%) and chronic kidney disease which prevented surgery as the treatment of choice. The polyp was successfully removed en-bloc by endoscopic mucosal resection technique without any complications like bleeding or perforation. Histopathology examination and immunohistochemistry confirmed the polyp to be a leiomyoma.
Introduction: Obscure gastrointestinal bleeding is a difficult medical emergency to manage. Benign small bowel tumors are rare cause of obscure gastrointestinal bleeding.
Methods: A 64 years old male presented with massive gastrointestinal bleeding with hemorrhagic shock. The patient had severe comorbid conditions like Diabetes Mellitus, Hypertension, Ischemic Heart Disease with cardiomyopathy (Ejection Fraction-30%) and Chronic Kidney Disease. After a nonconclusive Upper GI scopy, colonoscopy and a plain CT scan, capsule endoscopy was done which showed proximal jejunal bleeding. Push enteroscopy was the done, which showed a jejunal polyp measuring 3x2 cms.
Result: The polyp was successfully removed en-bloc by endoscopic mucosal resection technique without any complications like bleeding or perforation.Histopathology examination and immunohistochemistry confirmed the polyp to be a leiomyoma. Patient was asymptomatic on follow up at 6 months.
Conclusion: With adequate surgical back up, endoscopic resection of benign small bowel tumors can be done in selected high-risk group of patients in whom surgery may be associated with increased morbidity and mortality.
