Methylene Blue Enteric Mapping for Intraoperative Localization in Obscure Small Bowel Hemorrhage: Report of a New Technique and Literature Review

Background Small bowel sources of obscure gastrointestinal bleeding present both a diagnostic and therapeutic challenge. Due to the normal external appearance of the vast majority of small bowel lesions that cause obscure gastrointestinal bleeding, multiple methods of intraoperative localization hav...

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Bibliographic Details
Main Authors: Gifford, Shaun M, Peck, Michael A, Reyes, Angel M, Lundy, Jonathan B
Format: Report
Language:English
Subjects:
Anatomy and Physiology
ANGIOGRAPHY
CASE STUDIES
ENTERIC MAPPING
GASTROINTESTINAL SYSTEM
HEMORRHAGE
INTRAOPERATIVE LOCALIZATION
LESIONS
LITERATURE SURVEYS
MAPPING
Medicine and Medical Research
METHYLENE BLUE
SMALL BOWEL HEMORRHAGE
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Summary:Background Small bowel sources of obscure gastrointestinal bleeding present both a diagnostic and therapeutic challenge. Due to the normal external appearance of the vast majority of small bowel lesions that cause obscure gastrointestinal bleeding, multiple methods of intraoperative localization have been reported. When an arteriographic abnormality is found, the use of vital dye enteric mapping is one of the most effective localization techniques. Case Report We present a new technique combining superselective mesenteric angiography with methylene blue enteric mapping and small bowel resection performed during the same operative procedure. This technique was successfully applied in a patient with a jejunal arteriovenous malformation. Included is a review of methods of intraoperative localization with a focus on vital dye staining-guided enterectomy. Published in the Journal of Gastrointestinal Surgery, v16 p2177-2181, 2012.