Obscure Gastrointestinal Bleeding

Obscure gastrointestinal bleeding(OGIB)represents roughly five percent of all gastrointestinal draining and is characterized as seeping from an obscure cause that perseveres or repeats after endoscopy-negative demonstrative assessment.We present an instance of 21 years of age male who was admitted to our medical clinic with atypical presentation include amaurosis,on and off hematochezia worsen after seafood and alcohol consumption,past medical history showed that he had been treated in different hospitals without improvements,physical examination was uneventful with stable vitals,Endoscopy demonstrated a ulcer with raised edges and two Lumina in the ileum,and pathological result confirm chronic active inflammation of the mucosa with erosion.His final diagnosis was perforated meckel's diverticulum and ileocecal resection was done and he's currently stable during 6-months follow-up.IntroductionSeeping from the small bowel is uncommon but it is in charge of most of patients with gastrointestinal hemorrhage that endures or repeats without a conspicuous cause after lower and upper endoscopy,and maybe small intestine radiology assessment.In the past,if no source of bleeding was found after an endoscopic evaluation,the bleeding was referred to as being "obscure." However,more recently,it has been proposed that the term obscure only be used if patients have not had a wellspring of bleeding recognized after intensive test for the whole gastrointestinal system,including small intestine.Obscure gastro-intestinal discharge we suggest in this rule for previous phrase alluded to obscure GI bleeding be renamed as SB bleeding.and the reason behind this change in stating is inferable from the manner in which that the explanation behind draining would now have the option to be distinguished in a large portion of patients given advances in little gut imaging with video container endoscopy(VCE),profound enteroscopy,and radiographic picturing.The name obscure gastro-intestinal bleeding would then be put something aside for person in who wellspring of draining can't be distinguished anyplace in the gastro-intestinal system and may express to a wellspring of seeping outside of the small intestine.Ongoing advances have prompted renaming of gastro-intestinal bleeding into 3 parts:lower,middle,and upper gastro-intestinal bleeding.On off the chance that the wellspring of gastro-intestinal bleeding is in between:terminal ileum and ampulla Vater,and it is assigned bleeding middle gastro-intestinal.Due to a failure to imagine the small intestine legitimately,a person with a small intestine bleeding generally result in experiencing various indicative examinations,demanding.different hospitalizations or transfusions.in this manner,it is important to distinguish the etiological and the site of discharge precisely,in order to found suitable,powerful treatment.case studyA 21year old male referral from other emergency clinic with ileac lesions for more than 9 months had history of blood in stool after alcohol and seafood consumption for about 1800 g,reported to have history of transient amaurosis for three episodes,he has history of using Proton pump inhibitor prior to index admission,no ingestion of corrosive substances,don't have same history in the family.Past medical history family reported that he had a history of blood in the stool for his first year of age,which improved with no treatment,later the symptoms recur and has been treated as gastric ulcers at different hospital with no long-standing improvement.Physical examination;young energetic man,not wasted,not pale,not j aundicced,normal hair texture,peripheral lymph nodes were not palpable,no finger clubbing or lower limb edema.temperature was 36.1oc,blood pressure 140/90 mHg pulse rate was lOlbeats/minutes regular,normal volume,synchronous and non-collapsing,weight 73kg,height 170 cm.trachea central located,respiratory and cardiovascular examination were unremarkable,Gastrointestinal examination no distended abdomen,no caput medusa,normal bowel movement and sound,the liver and spleen were not palpable,murphy's sign(-).Figure 1 Endoscopy indicating pictured a polypoid mass with ruddy mucosa without villi.Laboratory test showed no significant abnormalities detected,sagittal CT showed normal lower abdomen(figure 4).The passageway of a Meckel's diverticulum.The scaffold between small bowe lumen and passageway is thickened with ulceration(figure 3),and there is raised nodular and polypoid injuries have a progressively ruddy mucosa without villi.(figure 2),ectopic gastric mucosa inside the Meckel's diverticulum can be legitimately pictured as a polypoid mass with rosy mucosa without villi(figure 1).Figure 1 Endoscopy indicating pictured a polypoid mass with ruddy mucosa without villi.Pathological results showed active chronic mucosal inflammation with erosion.Gastric biopsy and capsule endoscopy showed there was no obvious ulcer occupying and there was active bleeding in the lower part of small-intestine.Figure 2 Endoscopic results revealing elevated nodular and polypoid lesions Pathological results showed acute and chronic ileac mucosal inflammation,Eosinophils and small sized glandular dysplasia.Initial diagnoses were lower gastrointestinal bleeding,ileum lesions and treatment was offered including advised regular diet,PPIs and other medications and was admitted for further workout and improvement.Figure 3 Endoscopic signs demonstrating the extension between small bowel lumen and passage is thickened with ulcerationAfter all work out,final diagnosis was perforated meckle's diverticulum and was scheduled for laparoscopic surgery for small bowel disease resection.He underwent surgery and no post-operative complications were complained.Figure 4 abdominal CT reconstruction showing normalThe third post-operative day,patient fully recovered and was discharged from hospital with PPIs and other medication.During regular follow ups he had no new complaints and following a half year of development,patient was entirely steady with no new grumblings.DiscussionGastrointestinal bleeding is a noteworthy reason for crisis emergency clinic participation in grown-ups.around 80.5%of this seeping in grown-ups begins adjacent to the tendon of Treitz.colon is the most widely recognized wellspring of the lower gastrointestinal seeping,with less than five percent of seeping from SB.Mekel diverticulum(MD)is the greatest widely recognized intrinsic deformity of the gastrointestinal tract,most examinations propose a frequency of somewhere in the range of 0.6%and 4%.It is additionally the most well-known reason for bleeding in the pediatric age gathering.Our patient was determined to have iliac ulcer and made do with PPIs and and other drugs with little improvements,since he had a history of blood in stools at the early age(first year)further investigative test was offered and treated without improvements.The results showed that Ulcers were diagnosed in small intestine Meckle's diverticulum before initiation of the treatment.In our case,we found that alcohol and seafood consumption was the precipitants of the current admitting symptoms,with the fact that alcohol has impact on gastric walls and probably led to corrosion of the iliac walls.There was also a problem of intestinal hemorrhage in the small intestine vasodilation which was repeated after difficulties of other methods.and there was also acute and chronic ileac mucosal inflammation for which surgery was done later.After several surgeries at long last the patient was treated successfully and was discharged from the hospital.ConclusionThe diagnosis gives a very occasional and interesting case of obscure GI bleeding,the small intestinal bleeding is triggered by drinking alcohol and eating sea food,alcohol can chafe the GI tract and result in GI hemorrhage or ulcers.The condition should be checked as early as possible to reduce the fatal incidence at adult stages.