Surgery for a small intestine haemorrhage with use of a laparoscope for localization of the bleeding site

Andrzej Żyluk, Włodzimierz Majewski


Unlike in other parts of the digestive tract, the localization of a haemorrhage site in the small intestine is difficult. In the case of massive bleeding and the need for an urgent operation, localization of the area or site of bleeding in the small bowel may be challenging for the surgeon. The authors report a method of finding sites of bleeding using a laparoscope in a patient with massive gastrointestinal bleeding. Endoscopic diagnostics were inconclusive and an angio-CT revealed bleeding in the small bowel in the left middle-abdomen. Emergency laparotomy was performed with enterotomy and an inspection of the suspected part of the intestine with a laparoscope. Three sites of bleeding were found, of which one with active bleeding was ligated. Additionally, the small intestine parts over the bleeding sites were devascularized by ligation of arterial branches supporting them. This resulted in the bleeding stopping and the patient eventually recovering. The authors believe that the presented technique may be helpful in intraoperative localization of bleeding sites in the small bowel.


obscure gastrointestinal bleeding; small intestine; laparoscopy

Full Text:



Gerson LB. Small bowel bleeding: updated algorithm and outcomes. Gastrointest Endosc Clin N Am 2017;27(1):171-80.

Tziatzios G, Gkolfakis P, Papanikolaou IS, Triantafyllou K. Antithrombotic treatment is associated with small-bowel video capsule endoscopy positive findings in obscure gastrointestinal bleeding: A systematic review and meta-analysis. Dig Dis Sci 2019;64(1):15-24.

Wojtkiewicz P, Nowak T, Jankowski K, Łaski D. Diagnosis and treatment of obscure small bowel bleedings – analysis of double balloon enteroscopy role in diagnosing and treatment algorythm on basis of own material. Pol Przegl Chir 2018;90(3):25-30.

Sverdén E, Mattsson F, Lindström D, Sondén A, Lu Y, Lagergren J. Transcatheter arterial embolization compared with surgery for uncontrolled peptic ulcer bleeding: a population-based cohort study. Ann Surg 2019;269(2):304-9.

Tai FW, McAlindon ME. NSAIDs and the small bowel. Curr Opin Gastroenterol 2018;34(3):175-82.

Zhao L, Lu W, Sun Y, Liang J, Feng S, Shi Y, et al. Small intestinal diverticulum with bleeding: Case report and literature review. Medicine (Baltimore) 2018;97(9):e9871.

Chetcuti Zammit S, Koulaouzidis A, Sanders DS, McAlindon ME, Rondonotti E, Yung DE, et al. Overview of small bowel angioectasias: clinical presentation and treatment options. Expert Rev Gastroenterol Hepatol 2018;12(2):125-39.

Kim SH, Cho YH, Kim HY. Vascular malformations of the small intestine manifesting as chronic anemia: Two pediatric cases managed by single-site umbilical laparoscopic surgery. Int J Surg Case Rep 2017;31:233-6.

Yatagai N, Ueyama H, Shibuya T, Haga K, Takahashi M, Nomura O, et al. Obscure gastrointestinal bleeding caused by small intestinal lipoma: A case report. J Med Case Rep 2016;10:226.

Yamamoto M, Yamamoto K, Taketomi H, Yamamoto F, Yamamoto H. Obscure gastrointestinal bleeding due to a small intestinal gastrointestinal stromal tumor in a young adult. Case Rep Gastroenterol 2016; 10(3):668-73.


Copyright (c) 2021 Andrzej Żyluk

License URL: