First AD

Second AD

A 32-year-old woman presents with symptomatic anemia. A fecal occult blood test taken in the emergency room is positive. She undergoes an esophagogastroduodenoscopy (EGD) and colonoscopy, both of which are unrevealing. 

This patient presents with obscure occult gastrointestinal bleeding. She appropriately underwent an EGD and colonoscopy for evaluation. In the setting of a negative upper and lower endoscopy, the small bowel should be interrogated next. There are several ways to examine the small bowel including performing a push enteroscopy and video capsule endoscopy. The yield of capsule endoscopy is superior to push enteroscopy, as it has the potential to examine the entire small bowel, whereas push enteroscopy is limited to the proximal-mid jejunum. 

Intraoperative deep enteroscopy remains an option in rare cases where a lesion is known to exist and cannot be reached with an endoscope or if bleeding persists despite negative evaluation. In these cases, a surgeon can pleat the small bowel onto the endoscope.

What do you suspect as the source of the patient's GI bleeding? 

Gastrointestinal Disorders

Results of upper and lower endoscopy are inconclusive. Your next step?

Fecal Occult Blood Test, Positive: What Study Next?