A Case of Small Intestinal Bleeding in which the Hemorrhagic Point was Detected with a Long Intestinal Tube

Abstract

A 69-year-old man was brought to the ER with melena. Contrast-enhanced computed tomography showed intra-luminal bleeding of the small intestine. Emergent laparoscopic surgery was performed, but the bleeding point could not be detected. The patient showed progressive anemia. Since small bowel endoscopy could not be performed, a long nasal tube was inserted to try to identify the site of bleeding, focusing on the changes in drainage fluid characteristics as the ileus tube was advanced. A small incision was made from the tip of the ileus tube, and the source of the bleeding was identified by observation using a gastrointestinal endoscope. Obscure gastrointestinal bleeding (OGIB), which is often caused by a lesion of the small intestine, could be difficult to treat in cases where small bowel endoscopy is not available. In the present case, it was possible to identify the site of small intestinal bleeding using an ileus tube, which is easy to use in everyday practice. We believe that this simple method of identifying the source of bleeding using an ileus tube is highly useful, though there have been only a few reports of this method.