Publication: Clinical Practice Recurrent Severe Obscure Gastro Intestinal- Bleeding in a 20 Year Old Man
Date
2013
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu Unversity
Abstract
ABSTRACT
Morbus Osler-Weber-Rendu syndrome also known as Hereditary hemorrhagic
telangiectasia (HHT) and Meckel’s diverticulum is a rare combination disorder. Our
case presented with the recurrent obscure gastrointestinal (GI) bleeding for several
years. He came with a massive active lower gastrointestinal bleeding. Ultimatively,
he underwent an exploratory laparotomy along with intraoperative colonoscopy.
A Meckel’s diverticulum in combination with multiple erosions was found as a
probable cause of the massive gastrointestinal bleeding. An ileo-caeacal resection
had been performed and by the pathologist multiple telangiectasias in the resected
ileum were established. Blood was sent for genetics and was negative for ENG,
ALK-1, and SMAD-4 genes. The patient was discharged after 10 days from time of
admission and is under regular follow up without any further bleeding. In this case,
despite sophisticated techniques for investigations the cause of the GI-bleeding
with several esophagogastroduodenoscopies and colonoscopies, mesenteric
angiography and finally an oral double balloon enteroscopy was misdiagnosed till
the intra operative endoscopy showed a middle GI-bleeding. The management
for obscure GI-bleeding is discussed for countries with lower medical facilities like
Nepal in our case with Morbus Osler-Weber-Rendu syndrome.
KEY WORDS
Meckel`s diverticulum, middle gastrointestinal bleeding, morbus osler-weber-rendu
Description
Breidert M,1 Mandal A,2 Koller A,3 Huellebrand N,3 Malla B,4
Department of Internal Medicine
1District Hospital Clinic Altmühltal Germany, Teaching Hospital of the Technical University Munich, Germany
2Dhulikhel Hospital- Kathmandu University Hospital Teaching Hospital of the University of Kathmandu Nepal
3Department of Visceral Surgery District Hospital Clinic Altmühltal, Germany, Teaching Hospital of the Technical University Munich, Germany
4Department of Surgery Dhulikhel Hospital- Kathmandu University Hospital Teaching Hospital of the University of Kathmandu Nepal