Surgery saves the life of a patient with rare massive gastrointestinal bleeding

On July 8, Dr. Nguyen Quang Huy, Head of the General Surgery Department, People's Hospital 115, said that the hospital had just performed surgery to save the life of a female patient with rare massive gastrointestinal bleeding in a small intestine diverticulum.

Accordingly, patient LTBL (85 years old, living in Ba Ria-Vung Tau) had a history of high blood pressure and diabetes. The patient had symptoms of black stools so he was admitted to Vung Tau Hospital, then transferred to People's Hospital 115 in a state of frequent black stools and received a blood transfusion.

Doctor Quang Huy determined that this was a case of severe gastrointestinal bleeding. The patient was admitted to the hospital with pale skin and mucous membranes and a low red blood cell count. Within 4 days, the patient was transfused with 8 units of packed red blood cells and 8 units of fresh plasma. After the transfusion, the patient continued to have black stools many times, but hemodynamics remained stable. Gastric and colon endoscopy did not show any bleeding points.

Bệnh nhân chảy máu ở túi thừa ruột non, siêu âm, CT-Scanner, bội soi đều 'bó tay' - Ảnh 1. — Bleeding small intestine diverticulum is difficult to detect but dangerous for patients

The hospital also did a CT scan (computed tomography) of the blood vessels but still could not determine the location of the bleeding.

"Based on the severe blood loss and clinical signs of black stools, we suspected a high possibility of a bleeding focus in the small intestine. We decided to perform surgery combined with intraoperative flexible endoscopy to find the bleeding focus," said Dr. Quang Huy.

However, the problem was that the patient was old, weak, and had lost a lot of blood, making the family very worried about the risks that could occur from surgery. After listening to the doctors explain the critical condition, convince, and give detailed advice, the family and the patient agreed.

During the surgery, the doctor discovered a diverticulum in the first part of the small intestine, measuring 2x3 cm. The small intestine diverticulum had exposed blood vessels and was still bleeding, while the other parts of the small intestine were normal. The doctors decided to cut the part of the small intestine containing the bleeding diverticulum and reconnect the small intestine to restore intestinal circulation. After the surgery, the patient was stable and no longer had black stools and fresh blood.

According to Dr. Quang Huy, most small intestinal diverticula do not cause symptoms, but complications can occur: inflammation, diverticulum perforation, gastrointestinal bleeding, etc. Small intestinal diverticulum bleeding is a rare cause of gastrointestinal bleeding that can sometimes progress severely and threaten the patient's life. Diagnosis is often difficult because it is difficult to determine the location of the bleeding.

These small bowel diverticula occur in approximately 2-5% of the population and are probably caused by disturbances in small bowel motility. They are usually multiple and range in size from a few millimeters to 10 centimeters in length. Treatment options include endoscopic hemostasis, laparoscopic surgery, or open surgery.

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