Unusual Cause of Lower GI* Bleeding

Clinical Image

Austin J Surg. 2014;1(4): 1020.

Unusual Cause of Lower GI* Bleeding

Shebrain S1* and Ryan J1

1Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, USA

*Corresponding author: Shebrain S, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008

Received: July 29, 2014; Accepted: Aug 02, 2014; Published: Aug 06, 2014

Clinical Image

A 58 year-old male presented with 3-day history of painless, intermittent, bright red rectal bleeding associated with dizziness, fatigue and dyspnea. He appears pale with soft, non-tender abdomen. Hemoglobin is 7.1gm/dL. A colonoscopy showed blood in cecum without lesion. A computed tomography (CT) scan showed the lesion (Figure1). A laparoscopic en bloc segmental small bowel resection was performed.

Figure 1 :A CT scan of the abdomen showing enteroentericintussusception of the distal small bowel.






Figure 1 : A CT scan of the abdomen showing enteroentericintussusception of the distal small bowel.

The most common presentation of this condition is:

  1. Lower gastrointestinal bleeding
  2. Abdominal pain
  3. Weight loss
  4. Abdominal mass

Answer is (B)

Abdominal pain is the most common symptom in adult intussusception followed by vomiting and nausea or obstructive symptoms [1,2]. Other rare presentations include bleeding, abdominal masses, and diarrhea [1-4]. About 90% of cases have a lead point with the majority (70%) of these in the small bowel such as sub mucosal lipoma, polyp, and intussuscepting Meckel diverticulum [2,3]. This patient has intramuscular small bowel lipoma with mucosal ulceration (Figure 2).

Figure 2 :Gross picture of en bloc resected segment showing an intramuscular small bowel lipoma associated with mucosal ulceration.






Figure 2 : Gross picture of en bloc resected segment showing an intramuscular small bowel lipoma associated with mucosal ulceration.

Foot Note:

*Gastrointestinal bleeding

References

  1. Azar T, Berger DL. Adult intussusception. Ann Surg. 1997; 226: 134-138.
  2. Begos DG, Sandor A, Modlin IM. The diagnosis and management of adult intussusception. Am J Surg. 1997; 173: 88-94.
  3. Martín-Lorenzo JG, Torralba-Martinez A, Lirón-Ruiz R, Flores-Pastor B, Miguel-Perelló J, Aguilar-Jimenez J, et al. Intestinal invagination in adults: preoperative diagnosis and management. Int J Colorectal Dis. 2004; 19: 68-72.
  4. Tan KY, Tan SM, Tan AG, Chen CY, Chng HC, Hoe MN. Adult intussusception: experience in Singapore. ANZ J Surg. 2003; 73: 1044-1047.

Citation: Shebrain S and Ryan J. Unusual Cause of Lower GI* Bleeding. Austin J Surg. 2014;1(4): 1020. ISSN: 2381-9030.