Problem: Gastrointestinal bleeding with occult cause.
In our department for general surgery we quite frequently treat patients with obviously a gastrointestinal bleeding that many times even leads to the necessity to give several units of blood.
Many times, searching for the site of bleeding, we find nothing. Starting from gastroscopy and colonoscopy and even enteroklysma in many cases we are not able to identify a reason for bleeding or at least an area where the bleeding comes from. Often these patients are admitted to the hospital some time after this with another episode of (recent) bleeding.
We suspect angiodysplasy as the reason for most of these cases. But proof of this is very difficult: Many patients are admitted when there is no more acute bleeding, so colonoscopy only shows blood in the colon. As radiologists tell me, a flow of 4ml per minute is needed to show the bleeding vessel even in a superselective angiogram. Similar rates are true for nuclear medical methods. In all cases we tried these methods, we failed to reveal the bleeding site. Most times the bleeding is not sufficiently strong or the patient comes too late, the bleeding has already stopped.
So my question:
How would you act?
Do you (who? how many of you?) perform an elective right colectomy in these cases? (Literature says, 87% of angiodysplasy sites are in the right colon) If bleeding happens every 3 Months? every year? needing …. units of blood a year?
What would you do, if such a patient came twice a year, with haemoglobin 6 ?