Multiple Hemorrhagic Erosions

Unexplained bleeding may be found due to multiple erosions of the small intestine. A patient was found to have multiple ileal erosions and minimal bleeding, for which endo-scopic coagulation and hemostasis were performed (Fig. 10.4.5).

Fig. 10.4.5. Multiple hemorrhagic erosions a Mucosal erosion with bleeding in the ileum b Coagulation and hemostasis were performed on the lesion in a c Similar lesion at a different location of the ileum d Similar treatment was performed on the lesion in c


On the Mesenteric Side or the Opposite Side?

Double-balloon endoscopy allows differentiation of lesions on the mesenteric side and those on the opposite side. The double-balloon endoscopy is inserted so it stretches the mesentery in a fan shape and forms concentric circles with the pivot as a center. The intestinal wall facing the center of concentric circles is on the mesen-teric side. When the endoscope tip is moved toward the center of the circles under fluoroscopic guidance, the wall coming into the endoscopic view is the one on the mesenteric side.

■ References

1. Allison MC, Howatson AG, Torrance CJ, et al (1992) Gastrointestinal damage associated with the use of nonsteroidal anti-inflammatory drugs. N Engl J Med 327:749—754

2. Kessler WF, Shires GT 3rd, Fahey TJ 3rd (1997) Surgical complications of nonsteroidal antiinflammatory drug-induced small bowel ulceration. J Am Coll Surg 185:250—254

3. Bjarnason I, Price AB, Zanelli G, et al (1988) Clinicopathological features of nonsteroidal antiinflammatory drug-induced small intestinal strictures. Gastroenterology 94:1070—1074

4. Matsuhashi N, Yamada A, Hiraishi M, et al (1992) Multiple stricture of the small intestine after long-term nonsteroidal anti-inflammatory drug therapy. Am J Gastroenterol 87:1183—1186

5. Hayashi Y, Yamamoto H, Kita H, et al (2005) Non-steroidal anti-inflammatory drug-induced small bowel injuries identified by double-balloon endoscopy. World J Gastroenterol 11:4861-4864

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