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Hemorrhage from Primary Disease of the Mesenteric Small Intestine

1955; Elsevier BV; Volume: 28; Issue: 1 Linguagem: Inglês

10.1016/s0016-5085(55)80061-3

1528-0012

Gordon McHardy, John E. Bechtold, Robert J. McHardy,

Gastrointestinal Bleeding Diagnosis and Treatment

Bleeding from the small intestine distal to the duodenum is probably the rarest source of melena. Primary disease in this segment has been estimated to be responsible for only 2 per cent of instances of massive hemorrhage (1). Melena, however, is the most frequent manifestation of lesions of the small intestine (2). Among 276,981 admissions to Touro Infirmary in New Orleans over a 20year period from 1934 to 1954, there were 349 instances of bleeding of the upper intestinal tract of determinable origin. In 303 of these patients, bleeding originated proximal to the jejunum. The small intestine distal to the duodenum was established as a primary bleeding site in the other 46 patients, the jejunum in 22 and the ileum in 24. Bleeding was of obscure etiology in an additional 30 patients, in 12 of whom concomitant melena and hematemesis arose presumably from lesions proximal to the jejunum but unidentifiable. The other 18 patients manifested melena alone. The present report comprises an analysis of 216 instances of primary lesions of the mesenteric small intestine undertaken in an attempt to characterize hemorrhage of the small intestine. Table 1 shows the incidence of bleeding among these patients according to the site of the primary disease. In hemorrhage of the small intestine, the clinical history, although informative, does not definitely establish the site of bleeding. When hematemesis accompanies melena, in the absence of blood dyscrasia or portal hypertension, the probability of auleeding ulcer exceeds 70 per cent. Localization and etiology are often obscure when melena is the sole manifestation and the tract proximal to the jejunum and distal to the ileum has been reasonably excluded. In our study, we observed recurrent hemorrhage in 16 (34.8 per cent) of the 46 bleeding patients; recurrence was most frequent in Meckel's diverticulum and hemangioma. A single bleeding episode was recorded in 30 (65.2 per cent).