Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.157
Peer-review started: October 26, 2017
First decision: November 21, 2017
Revised: December 1, 2017
Accepted: December 4, 2017
Article in press: December 4, 2017
Published online: January 7, 2018
A 28-year-old man presented with anemia symptoms and intermittent tarry stool passage for three days. No stigmata of hemorrhage were identified using esophagogastroduodenoscopy, ileocolonoscopy, and contrast-enhanced computed tomography. He then developed massive tarry stool passage with profound hypovolemic shock and hypoxic respiratory failure. Emergent angiography revealed active bleeder, probably from the jejunal branches of the superior mesenteric artery, but embolization was not performed due to possible subsequent extensive bowel ischemia. His airway was secured via endotracheal intubation with ventilator support, and emergent antegrade single-balloon enteroscopy was performed at 8 h after clinical overt bleeding occurrence; the procedure revealed a 2-cm pulsating subepithelial tumor with a protruding blood plug at the distal jejunum. Laparoscopic segmental resection of the jejunum with end-to-end anastomosis was performed after emergent endoscopic tattooing localization. Pathological examination revealed a vascular malformation in the submucosa with an organizing thrombus. He was uneventfully discharged 5 d later. This case report highlights the benefit of early deep enteroscopy for the treatment of small intestinal bleeding.
Core tip: We believe that emergent deep enteroscopy performed with a secure airway and ventilator support can efficiently identify the stigmata of hemorrhage in clinical overt small intestinal bleeding and guide the operative approach.