Approach to lower gastrointestinal bleeding: A case report from the Chris Hani Baragwanath Academic Hospital

Résumé

Background: Obscure bleeding remains a real concern for patients and healthcare providers. Identifying the source of bleeding and subsequent management is sometimes very challenging. We present a case of a 42-year-old female who presented with lower gastrointestinal bleeding and the source of the bleed was located in the small bowel. 

Methods: The patient was referred to the hospital from a General Practitioner and underwent several investigations. A wireless video capsule endoscopy was finally used. 

Results: Several investigations were performed including an upper and lower scope, a computer tomography angiogram scan of the abdomen, and a red cell scan. These were all negative. The patient continued to bleed; a wireless video capsule endoscopy was finally done and telangiectasia was found in the small bowel as the source of the bleeding. 

Conclusion: Obscure bleeding can be frustrating for both the patient and the doctor. Unless the patient is bleeding significantly, the source of bleeding is usually not found by a computer tomography angiogram scan. A nuclear medicine scan could help in identifying the source of the bleed, but the specificity is quite low. Is there a case to be made to rather do a capsule endoscopy test at first presentation?