Delayed Ileal Hemorrhage After Blunt Abdominal Trauma Successfully Managed With Capsule Endoscopy: A Case Report

TL;DR

An elderly man with delayed ileal bleeding after abdominal trauma was successfully diagnosed and managed using capsule endoscopy, avoiding surgery.

Contribution

This case report demonstrates the utility of capsule endoscopy in managing delayed post-traumatic small bowel bleeding.

Findings

Delayed ileal hemorrhage after blunt trauma was successfully managed with capsule endoscopy.

Capsule endoscopy provided definitive mucosal assessment and clarified the etiology of recurrent bleeding.

Conservative management guided by capsule endoscopy avoided unnecessary laparotomy.

Abstract

Blunt abdominal trauma typically results in solid organ injury, while hollow viscus injury is rare but associated with high morbidity when diagnosis is delayed. Delayed complications most often manifest as stenosis, necrosis, or, less commonly, perforation, which, although typically an early complication, has also been reported in delayed settings; moreover, delayed intraluminal hemorrhage is exceptionally uncommon. We present the case of an 84-year-old man who sustained blunt abdominal trauma after a fall. Initial computed tomography demonstrated a perihepatic hematoma and segmental ileal wall edema without extravasation, and conservative management was initiated. Hematochezia occurred on hospital days 3 and 16, with angiography confirming active bleeding from a superior mesenteric artery branch, successfully treated with coil embolization. Despite transfusion of 16 units of red blood cells, recurrent bleeding continued until day 26, though subsequent imaging revealed no extravasation. To further evaluate, a patency capsule was administered, confirming luminal patency, followed by capsule endoscopy on day 36. Capsule images revealed multiple healing ileal ulcers without active bleeding or stenosis. Based on these findings, conservative management was continued, and the patient was discharged on day 70 without recurrence. This case highlights the diagnostic and therapeutic challenges of delayed post-traumatic small bowel bleeding, a rare but clinically significant condition. Conventional imaging and angiography often fail to distinguish healing from ongoing hemorrhage, leaving management decisions uncertain. Capsule endoscopy, safely preceded by patency testing, provided definitive mucosal assessment, clarified the etiology, and guided nonoperative management, thereby avoiding unnecessary laparotomy. Capsule endoscopy should be considered a valuable adjunct in trauma care for stable patients with unexplained recurrent bleeding, as it has the potential to refine diagnostic algorithms and reduce morbidity.

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