Massive obscure GI bleeding from Idiopathic Jejunal varices identified using single balloon enteroscopy
Bibliographic record
Abstract
Background: Obscure gastrointestinal bleeding from idiopathic small bowel varices is both a diagnostic and management challenge for physicians. There are very few cases reported in the literature and there is no consensus on management recommendations. Aims: To present the case of a 34-year-old male patient with bleeding from idiopathic jejunal varices and to review similar cases in the literature. Methods: A case of idiopathic jejunal varices is reported. A literature review was conducted and a total of 24 articles describing idiopathic small bowel varices were identified. Results: Case Report: A 34-year-old gentleman was referred for worsening obscure gastrointestinal bleeding and anemia. Anterograde single balloon enteroscopy revealed several petechial like lesions that were not classic for angiodysplasia. These lesions were initially treated with argon plasma coagulation and clipped, which did not resolve the patient’s persistent anemia. No venous abnormalities were identified on computed tomography of the abdomen and pelvis with contrast. The patient underwent an endoscopically assisted exploratory laparoscopy that was converted to a laparotomy upon finding of grossly abnormal distal jejunum. Dilated and tortuous varicosities were identified involving approximately 150 cm of small bowel. It was decided to resect the 40 cm segment of jejunum in which varices were visible endoscopically. There was no evidence of thrombosis in the resected specimen. The patient suffered a pulmonary embolism post-operatively, believed to be provoked by the surgery. The patient has had no re-bleeding 12 months post-resection. Literature Review: Both familial and non-familial accounts of small bowel varices in the absence of a primary cause have been reported in the literature. When supportive therapy is insufficient, the most common treatment modality chosen is surgical resection. Select cases have also demonstrated that sclerotherapy and varix dissection can be used for to treat these lesions. Conclusions: Idiopathic small bowel varices pose both diagnostic and therapeutic challenges for physicians. In the literature, several treatment modalities have been shown to be successful; these include surgical resection, varix dissection and sclerotherapy. There is no consensus on the preferred treatment strategy. This report demonstrates endoscopically assisted surgical resection as a viable management strategy for bleeding of idiopathic small bowel varices, an uncommon cause of occult GI bleeding.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".