Small Bowel Anastomotic Ulcers As A Rare Cause Of Anemia/Overt Gastrointestinal Bleeding In Patients With A Previous Non-Ibd Related Small Intestine Resection

Aims Anastomotic ulcers represent a serious complication after gastrointestinal (GI) surgery. They have been described as mainly associated to bariatric surgery and colonic resection with ileocolic anastomosis. No data regarding small bowel (SB) anastomotic ulcerations after SB resection are currently available in literature.

Patients with anemia/overt obscure GI bleeding (OGIB), who previously had non-inflammatory bowel diseases (IBD)-related SB resection, underwent capsule endoscopy (CE) after negative endoscopic examinations.

The aim of this retrospective study is to evaluate the percentage of SB anastomotic ulcers as a cause of anemia/overt OGIB in patients with non-IBD-related SB resection (i.e. volvulus, intra-abdominal adherences, intussusception, Meckel’s diverticulum).

Methods CE was performed after negative endoscopic examinations. An expert team reviewed the CE images of 800 male and female patients, collected between January 2011 and January 2019. Demographic and CE data were retrieved from our endoscopic database.

Results 13 over 800 patients (1.6 %) were diagnosed with SB anastomotic ulcerations. Among these patients, 6 were female and 7 were male. The median age was 59 years (range 8-77). 5 over 13 patients (38 %) had diabetes mellitus and/or cardiovascular diseases; 3 patients (23 %) were under anticoagulant/antiplatelet therapy.

Conclusions Our study showed that SB anastomotic ulcerations are a rare cause of anemia/overt OGIB in patients with non-IBD SB resection. Anticoagulant/antiplatelet therapy may increase the possibility of bleeding from these lesions. Age may also represent a predisposing factor, as the majority of patients were adult/elderly people. Moreover, comorbidities such as diabetes mellitus or other metabolic and cardiovascular diseases may contribute to SB ulcers formation.

In conclusion, when anemia/OGIB occur in patients with a non-IBD SB resection and endoscopic examinations are negative, we suggest searching for SB anastomotic ulcers at CE, as they can be a possible cause of patients’ signs and symptoms, especially in adult/elderly patients with cardiovascular and/or metabolic diseases.

Citation Purchiaroni F, Marmo C, Costamagna G et al. eP112SMALL BOWEL ANASTOMOTIC ULCERS AS A RARE CAUSE OF ANEMIA/OVERT GASTROINTESTINAL BLEEDING IN PATIENTS WITH A PREVIOUS NON-IBD RELATED SMALL INTESTINE RESECTION. Endoscopy 2021; 53: S133.

Publication History

Article published online:
19 March 2021