Exploratory laparoscopy for patients with obscure gastrointestinal bleeding

We have used laparoscopy as a diagnostic and therapeutic option in the evaluation of pts with obscure GI bleeding. This is a retrospective analysis of 12 pts who underwent laparoscopy for obscure GI bleeding. The pts, mean age 43, had been bleeding for a mean of 15.5 mos; and had been transfused a mean of 7.8 units prbcs. Previous workup had included EGDs and colonoscopies in-all; push enteroscopy an 9, small bowel series and/or enteroclyses in 8, bleeding scans and angiograms in 6, Meckel's scans and CT scans in 4. No diagnosis was made in any of these. A preoperative diagnosis was made in 4 during sonde enteroscopy performed in 5 pts. Primary exploratory laparoscopy was performed in 8. These pts had a suspected small bowel tumor suggested by young age in 7 and obstructive type symptoms in 1. Laparoscopy was performed first using deep reverse Trendelenburg to see if a tumor would fall into the pelvis. The bowel was then run using 2 endosponge sticks starting at the ileocecal valve till the ligament of Treitz was reached. A negative exam consisted of running the bowel a total of 3 times. Tumors were resected endoscopically and removed through a small incision. Laparoscopy in 12 pts yielded 10 positive results including 2 leiomyomas, 2 melanomas, 1 leiomyosarcoma, 1 adenocarcinoma, 1 carcinoid, 1 endometrioma, a Meckel's diverticulum, and 1 unsuspected Crohn's disease. A diagnosis was made in 6/8 pts (75%) who had laparoscopy as a primary test. Exploratory laparoscopy is a viable option in pts with obscure GI bleeding especially if a small bowel tumor or Meckel's diverticulum is suspected.