Abstract
A 16-year-old man was brought into our hospital by ambulance because of the abrupt onset of massive anal bleeding. An abdominal contrast-enhanced CT scan showed arterial bleeding from the small intestine and an angiography revealed bleeding from the ileal artery. Vascular embolization and coiling achieved hemostasis. We performed single-balloon enteroscopy and video capsule endoscopy to localize the source of the bleeding several days later. A submucosal aneurysm of the small intestine was suspected by video capsule endoscopy. We decided to conduct an elective surgery. A single incisional laparoscopic assisted partial jejunectomy was performed for the purpose of diagnosis and hemostasis. The pathological diagnosis was a ruptured submucosal aneurysm. His postoperative course was uneventful and he was discharged on the 7th postoperative day. Small bowel hemorrhage has been reported to account for about 2-5% of all cases of gastrointestinal bleeding. Ruptured small bowel aneurysm is extremely rare. We often have difficulties in making preoperative diagnosis of small bowel hemorrhage but in this case the comcomitant use of angiography, single-balloon enteroscopy and video capsule endoscopy was useful for diagnosis of bleeding site. We resultantly performed less invasive surgery.
