{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T20:11:55Z","timestamp":1793045515598,"version":"4.5.0"},"reference-count":21,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1987,1]]},"abstract":"<jats:p>The investigation and treatment of 131 patients with 'obscure' gastrointestinal bleeding has been reviewed. One hundred and six patients were assessed electively for recurrent haemorrhage, 25 presented as emergencies. The major presenting feature was melaena (55 patients), anaemia (35), rectal bleeding (34), haematemesis (six) and ileostomy bleeding (one). The lesions responsible for haemorrhage were colonic angiodysplasia (52 patients), small bowel vascular anomalies (16), Meckel's diverticula (nine), small bowel smooth muscle tumours (seven), gastric vascular anomalies (four), chronic pancreatitis (three), colonic diverticular disease (three) and 16 other miscellaneous lesions. No lesion was found in 21 cases. Lesions were first shown by visceral angiography (69 patients), at laparotomy (23), on endoscopy (11), on gastrointestinal contrast radiological studies (four), and at ERCP (three). Lesions which were undetectable at operation increased markedly with age (p less than 0.0001). Expert visceral angiography is strongly recommended before surgery in patients over 45 years of age and after laparotomy when no cause has been found. Exploratory laparotomy is recommended at an early stage for younger patients, and for older patients after non-diagnostic angiography.<\/jats:p>","DOI":"10.1136\/gut.28.1.47","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"47-51","source":"Crossref","is-referenced-by-count":70,"title":["Specialist investigation of obscure gastrointestinal bleeding."],"prefix":"10.1136","volume":"28","author":[{"given":"J N","family":"Thompson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R R","family":"Salem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A P","family":"Hemingway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H C","family":"Rees","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H J","family":"Hodgson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C B","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D J","family":"Allison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Spencer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1987,1,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/bjs.1800700812","article-title":"Recurrent gastrointestinal bleeding of obscure origin: report of 17 cases and a guide to logical management","volume":"70","author":"Spiller, R.C.; Parkins, R.A.","year":"1983","unstructured":"Spiller RC, Parkins RA. Recurrent gastrointestinal bleeding of obscure origin: report of 17 cases and a guide to logical management. Br J Surg 1983; 70: 489-93.","journal-title":"Br J Surg"},{"key":"ref_2","first-page":"92","article-title":"Diagnosis and management of occult gastrointestinal bleeding: visualization of the small bowel lumen by fiberoptic colonoscope","volume":"42","author":"Myers, R.T.","year":"1976","unstructured":"Myers RT. Diagnosis and management of occult gastrointestinal bleeding: visualization of the small bowel lumen by fiberoptic colonoscope. Am Surg 1976; 42: 92-5.","journal-title":"Am Surg"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1136\/bmj.288.6431.1663","article-title":"Obscure gastrointestinal haemorrhage of small-bowel origin","volume":"288","author":"Thompson, J.N.; Hemingway, A.P.; McPherson, G.A.D.; Rees, H.C.; Allison, D.J.; Spencer, J.","year":"1984","unstructured":"Thompson JN, Hemingway AP, McPherson GAD, Rees HC, Allison DJ, Spencer J. Obscure gastrointestinal haemorrhage of small-bowel origin. Br Med J 1984; 288: 1663-5.","journal-title":"Br Med J"},{"key":"ref_4","first-page":"225","article-title":"A comparison of colonoscopy and selective visceral angiography in the diagnosis of colonic angiodysplasia","volume":"67","author":"Salem, R.R.; Wood, C.B.; Rees, H.C.; Kheshavarzian, A.; Hemingway, A.P.; Allison, D.J.","year":"1985","unstructured":"Salem RR, Wood CB, Rees HC, Kheshavarzian A, Hemingway AP, Allison DJ. A comparison of colonoscopy and selective visceral angiography in the diagnosis of colonic angiodysplasia. Ann R Coll Surg Engl 1985; 67: 225-6.","journal-title":"Ann R Coll Surg Engl"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"338","DOI":"10.2214\/ajr.123.2.338","article-title":"Angiographic evaluation of patients with chronic gastrointestinal bleeding","volume":"123","author":"Sheedy, P.F.; Fulton, R.E.; Atwell, D.T.","year":"1975","unstructured":"Sheedy PF, Fulton RE, Atwell DT. Angiographic evaluation of patients with chronic gastrointestinal bleeding. Am J Roentgenol Radium Ther Nucl Med 1975; 123: 338-47.","journal-title":"Am J Roentgenol Radium Ther Nucl Med"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1001\/archsurg.1975.01360110207036","article-title":"Occult gastrointestinal bleeding: an evaluation of available diagnostic methods","volume":"110","author":"Richardson, J.D.; McInnis, W.D.; Ramos, R.; Aust, J.B.","year":"1975","unstructured":"Richardson JD, McInnis WD, Ramos R, Aust JB. Occult gastrointestinal bleeding: an evaluation of available diagnostic methods. Arc\/i Surg 1975; 110: 661-5.","journal-title":"Arc\/i Surg"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/00000658-198007000-00019","article-title":"Colonoscopy in the diagnosis of unexplained rectal bleeding","volume":"192","author":"Brand, E.J.; Sullivan, B.H.; Sivak, M.V.; Rankin, G.B.","year":"1980","unstructured":"Brand EJ, Sullivan BH, Sivak MV, Rankin GB. Colonoscopy in the diagnosis of unexplained rectal bleeding. Ann Surg 1980; 192: 111-3.","journal-title":"Ann Surg"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/0002-9610(81)90143-4","article-title":"Lower gastrointestinal bleeding: diagnostic approach and management conclusions","volume":"141","author":"Nath, R.L.; Sequeira, J.C.; Weitzman, A.F.; Birkett, D.H.; Williams, L.F.","year":"1981","unstructured":"Nath RL, Sequeira JC, Weitzman AF, Birkett DH, Williams LF. Lower gastrointestinal bleeding: diagnostic approach and management conclusions. Am J Suirg 1981; 141: 478-81.","journal-title":"Am J Suirg"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"789","DOI":"10.2214\/ajr.129.5.789","article-title":"Angiodysplasia of the right colon: a cause of gastrointestinal bleeding","volume":"129","author":"Baum, S.; Athanasoulis, C.A.; Waltman, A.C.","year":"1977","unstructured":"Baum S, Athanasoulis CA, Waltman AC et al. Angiodysplasia of the right colon: a cause of gastrointestinal bleeding. AJR 1977; 129: 789-94.","journal-title":"AJR"},{"key":"ref_10","first-page":"137","article-title":"Colonic ectasias and lower intestinal bleeding. Hosp Pract","volume":"17","author":"Boley, S.J.; Brandt, L.J.","year":"1982","unstructured":"Boley SJ, Brandt LJ. Colonic ectasias and lower intestinal bleeding. Hosp Pract 1982; 17: 137-44."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/BF01574466","article-title":"Haemorrhage from the large bowel with special reference to angiodysplasia and diverticular disease","volume":"2","author":"Welch, C.E.; Athanasoulis, C.A.; Galdabini, J.J.","year":"1978","unstructured":"Welch CE, Athanasoulis CA, Galdabini JJ. Haemorrhage from the large bowel with special reference to angiodysplasia and diverticular disease. World J Surg 1978; 2: 73-83.","journal-title":"World J Surg"},{"issue":"289","key":"ref_12","first-page":"108","article-title":"Obscure bleeding from the small bowel","volume":"1984","author":"Brearley, S.; Ambrose, N.S.; Silverman, S.; Hawker, P.C.; Dorricott, N.J.; Keighley, M.R.B.","unstructured":"Brearley S, Ambrose NS, Silverman S, Hawker PC, Dorricott NJ, Keighley MRB. Obscure bleeding from the small bowel. 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Angiodysplasia [Editoriall Lancet 1981; ii: 1086-7.","journal-title":"Angiodysplasia [Editoriall Lancet"},{"key":"ref_15","first-page":"453","article-title":"Intraoperative angiography in intestinal angiodysplasia","volume":"152","author":"Hines, JR, Stryker; SJ, Neiman; H.L.","year":"1981","unstructured":"Hines JR, Stryker SJ, Neiman HL et al. Intraoperative angiography in intestinal angiodysplasia. Suirg Gyniecol Obstet 1981; 152: 453-60.","journal-title":"Suirg Gyniecol Obstet"},{"key":"ref_16","first-page":"637","article-title":"Intraoperative angiography and the localisation of bleeding from the small intestine","volume":"151","author":"Fazio, V.W.; Zelas, P.; Weakley, F.L.","year":"1980","unstructured":"Fazio VW, Zelas P, Weakley FL. Intraoperative angiography and the localisation of bleeding from the small intestine. Surg Gynecol Obstet 1980; 151: 637-40.","journal-title":"Surg Gynecol Obstet"},{"key":"ref_17","first-page":"77","article-title":"Intraoperative localisation of small bowel bleeding sites with combined use of angiograiphic methods and methylene blue injection","volume":"87","author":"Athanasoulis, C.A.; Moncure, A.C.; Greenfield, A.J.; Ryan, J.A.; Dobson, T.F.","year":"1980","unstructured":"Athanasoulis CA, Moncure AC, Greenfield AJ, Ryan JA, Dobson TF. Intraoperative localisation of small bowel bleeding sites with combined use of angiograiphic methods and methylene blue injection. Surgery 1980; 87: 77-84.","journal-title":"Surgery"},{"key":"ref_18","first-page":"45","article-title":"Right-sided colonic diverticula as a cause of acute rectal haemorrhage","volume":"286","author":"Casarella, W.J.; Kanter, I.E.; Seaman, W.B.","year":"1972","unstructured":"Casarella WJ, Kanter IE, Seaman WB. Right-sided colonic diverticula as a cause of acute rectal haemorrhage. N Engl J Med 1972; 286: 45(-3.","journal-title":"N Engl J Med"},{"key":"ref_19","first-page":"30","article-title":"Angiography in gastrointestinal bleeding","volume":"ii:","author":"Allison, D.J.; Hemingway, A.P.; Cunningham, D.A.","year":"1982","unstructured":"Allison DJ, Hemingway AP, Cunningham DA. Angiography in gastrointestinal bleeding. Lancet 1982; ii: 30-3.","journal-title":"Lancet"},{"key":"ref_20","first-page":"285","article-title":"Angiodysplasia of the colon: a post-mortem study","volume":"27","author":"Sabanathan, S.; Nag, S.B.","year":"1982","unstructured":"Sabanathan S, Nag SB. Angiodysplasia of the colon: a post-mortem study. J R Coll Surg Edinb 1982; 27: 285-91.","journal-title":"J R Coll Surg Edinb"},{"key":"ref_21","first-page":"569","article-title":"Case no 36-1974; Case records of the Massachusetts General Hospital","volume":"291","author":"Galdabini, J.J.","year":"1974","unstructured":"Galdabini JJ. 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