Successful Management of Acute Obscure Gastrointestinal Bleeding (OGIB) Using Long Tube-Directed Hemostasis: A Case Report

TL;DR

A 74-year-old man with severe, unexplained gastrointestinal bleeding was successfully treated using a long tube to deliver clotting agents directly to the bleeding site.

Contribution

This case report introduces long tube-directed hemostasis as a novel approach for managing acute, severe OGIB when conventional methods fail.

Findings

Localized administration of thrombin and Yunnan Baiyao via a long tube achieved hemostasis within 24 hours.

The patient's hemoglobin stabilized, and he was discharged after 10 days without further complications.

Abstract

Obscure gastrointestinal bleeding (OGIB) is characterized by persistent or recurrent bleeding without a clear source despite standard endoscopic and radiographic investigation. Acute, severe OGIB presents a significant therapeutic challenge, particularly when hemodynamic instability precludes invasive diagnostic procedures. A 74-year-old Asian man presented with acute, severe OGIB and massive hematochezia. Initial laboratory tests revealed severe anemia (hemoglobin 31 g/L) and hypofibrinogenemia (0.95 g/L). Despite negative findings on gastroscopy, colonoscopy, abdominal CT, and angiography, and despite aggressive resuscitation with fluids, blood products, and hemostatic agents, bleeding persisted. A long tube was placed under fluoroscopic guidance, and bloody aspirate confirmed its distal jejunal position. Localized administration of thrombin and Yunnan Baiyao via the long tube achieved hemostasis within 24 hours, and the patient's hemoglobin stabilized. He was discharged after 10 days. This case demonstrates the successful use of long tube-directed hemostatic therapy in acute, severe OGIB when conventional methods are inconclusive and further diagnostic evaluation is limited by the patient's clinical condition. This approach may represent a valuable alternative for achieving hemostasis and bridging patients to definitive therapy. Further research is warranted to confirm the efficacy and safety of this technique.

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