ULCERS THIN-INTESTINAL ANASTOMOSIS AS THE SOURCE OF BLEEDING IN PATIENTS WITH RESECTION OF THE SMALL INTESTINE IN HISTORY

Objectives: to evaluate the etiology of anastomotic ulcers (AU), being the sources of small bowel bleeding, using clinical, instrumental features and results of treatment. Materials and methods: From 14.02.2007 to 30.10.2017 from 213 patients, having applied to our hospital with suspected small bowel bleeding, AU were revealed in 8 (3,7%) pts (m-7, f-1, mean age 38,0±14,4 years, range 19-59). There were 7 (87,5%) pts. with obscure overt and 1 (12,5%) with obscure occult bleeding. Diagnostic procedures included videocapsule endoscopy (VCE) and balloon-assisted enteroscopy (BAE) in all of pts. VCE was performed in 6 (75,0%) pts, followed by BAE, which was ineffective in 2 cases. BAE was performed in all 8 pts: it was effective in 6 cases, including 2 pts without previous VCE. Results: Anastomotic ulcers were initially revealed, using VCE, in all cases, then - confirmed using BAE (4) and surgery (2); using only BAE - in 2 pts. Initial conservative treatment, recommended to 6 (75,0%) pts, was effective in 1 case; in other 5 cases surgery was performed because of persisted anemia and rebleeding episodes. Surgery at once was performed in 2 (25,0%) pts. After surgery and histology in 7 pts we revealed ulcers at the anastomotic area in 4 (57,1%) pts, in the middle of long blind loops area in 3 (42,9%) pts. Signs of ischemia and Crohn’s disease were not revealed. Suture material was detected in ulcer bases in 2 (28,6%) pts. All patients have been free of relapse (1-7 years). Conclusions: Using VCE and BAE gave the opportunity to reveal the source of bleeding in pts with AU, suffering for a long time. Having analysed surgery and histology results in 7 pts, we can suppose, that long blind loops, as well as suture material can lead to anastomotic ulceration in patients after SB resection. Further accumulation of clinical material is needed for complete analysis of etiology of AU.

anastomotic ulcers, small bowel bleeding, small bowel resection, enteroscopy

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