Case of Bleeding Ileal Varices after a Colectomy Diagnosed by Capsule Endoscopy

• Published in: The Korean journal of gastroenterology Vol. 71; no. 6; pp. 349 - 353
• Main Authors: Park, Chang Joon, Lee, Bong Eun, Jeon, Hye Kyung, Kim, Gwang Ha, Song, Geun Am, Ko, Sang Hwa, Lee, So Jeong, Park, Do Youn
• Format: Journal Article
• Language: English
• Published: Korea (South) Jin Publishing & Printing Co 25.06.2018; 대한소화기학회
• Subjects: Aged; Capsule Endoscopy; Colectomy; Female; Gastrointestinal hemorrhage; Gastrointestinal Hemorrhage - diagnosis; Humans; Ileum - pathology; Intestinal Mucosa - pathology; Melena - diagnosis; Tomography, X-Ray Computed; 내과학; Capsule endoscopy; Gastrointestinal hemorrhage
• ISSN: 1598-9992; 2233-6869
• DOI: 10.4166/kjg.2018.71.6.349

We report a case of bleeding ileal varices associated with intra-abdominal adhesions after colectomy which was successfully diagnosed using capsule endoscopy. A 77-year-old woman visited the emergency department for several episodes of melena. She had a medical history of neoadjuvant chemo-radiation therapy and subsequent surgery for rectal cancer 6 years previously. Conventional diagnostic examinations including upper endoscopy, colonoscopy, and abdominal computed tomography could not detect any bleeding focus, however, following capsule endoscopy revealed venous dilatations with some fresh blood in the distal ileum, indicating bleeding ileal varices. The patient underwent exploratory laparotomy and the affected ileum was successfully resected. No further gastrointestinal bleeding occurred during the 6 months follow-up. Small intestinal varices are important differential for obscure gastrointestinal bleeding especially in patients with a history of abdominal surgery in the absence of liver cirrhosis, and capsule endoscopy can be a good option for diagnosing small intestinal varices.