Hidden gastrointestinal bleeding, a rhetorical diagnosis

Abstract

Background: Hidden gastrointestinal bleeding represents approximately 5% -10% of total gastrointestinal bleeding. Clinical case description: 62 years old, female patient from Santa Cruz de Yojoa, Cortés. Without comorbidities, who reports intermittent episodes of mane of 1 year of evolution. Evaluated and managed with parenteral iron and blood transfusions. Studies were performed, without finding the source of the bleeding. She underwent diagnostic laparoscopy in June 2019, performing an appendectomy, jejunal resection, cholecystectomy, and oophorectomy; staying asymptomatic after surgery. In December, restarts with mane, 3-4 episodes daily, abundant quantity, (approximately 300 ml). Evaluated again without being able to identify the origin of the bleeding, for which endoscopic video capsule was performed, that reported hematic remains without observing the bleeding site. A push enteroscopy and a duodenoscopy were performed, observing a bleeding site close to the duodenal papilla. It was decided to perform angiotomography, which was compatible with digestive bleeding at the level of the II and III portion of the duodenum. Then a selective arteriography of abdominal vessels is performed, showing leakage of contrast medium originating in the right hepatic artery of origin in the superior mesenteric. Finally, 2 hemoclips were applied endoscopically, obtaining a satisfactory result. Conclusions: The type of lesion responsible for small bowel bleeding depends on the age of the patient. Risk factors for recurrent bleeding from angioectasia include number of lesions, advanced age, comorbidities, and anticoagulant therapy.