A case of malignant lymphoma of the small intestine with successful endoscopic hemostasis using double-balloon enteroscopy

Abstract

A 69 year-old woman was admitted to our hospital because of a tarry stool and severe anemia. She was diagnosed with small bowel bleeding due to malignant lymphoma distributed from the distal portion of the duodenum to the ileum by using double-balloon enteroscopy. Then, she became hypovolemic shock due to large blood loss from the gastrointestinal tract. ^99mTcO4^-scintigraphy indicated bleeding from the small intestine. In order to control bleeding from the small intestine, double-balloon enteroscopy was carried out in emergency and the electrocoagulation therapy was performed after the identification of the bleeding lesion. While the technique of endoscopy usually provides visualization of the most proximal and distal end of the gut. The small bowel is among the most difficult part of the gastrointestinal tract to access. Both small bowel radiograophy and capsule endoscopy are useful for the diagnosis of the small intestine, but interventional capabilities are totally absent in these methods. Conventional push enteroscopy provides tremendous discomfort to the patient, and cannot access to the entire small bowel as well. The double-balloon method is a new technique capable of accessing entire small intestine with intervention capabilities. We have demonstrated a case in which double-balloon enteroscope was very helpful not only for the diagnosis of small bowel tumors but also for the control of bleeding from the tumor in the small intestine.