Intraoperative Enteroscopy—a Tool for the Diagnosis of Obscure Gastrointestinal Bleeds

Obscure gastrointestinal bleed accounts for 5% of all cases of gastrointestinal bleed and to date remains a diagnostic challenge to the surgeon. There are newer diagnostic modalities available to diagnose the cause for bleed. The accuracy of these tests range from 40 to 80% and major limitations include cost, availability, and the need for a specialist to carry out these tests. On-table intraoperative enteroscopy is an easily available diagnostic modality which can be performed by general surgeons themselves with accuracy rates either comparable with or better than the newer diagnostic modalities. In this study, we present three cases of obscure gastrointestinal bleed where the cause was diagnosed with on-table enteroscopy. Three middle-aged patients presented to us with obscure gastrointestinal bleeding. The cause of bleeding was localized with on-table intraoperative enteroscopy. Following appropriate surgical management, patients recovered well and have had no recurrent episodes of bleed so far. Obscure gastrointestinal bleed is a difficult clinical problem. While many types of investigations are available to localize the site of bleed, they have the limitations of cost and availability. Intraoperative enteroscopy is a useful, easily performed, and generally available facility. Its morbidity has to be weighed against its considerable advantages. We believe that it deserves to be used more often than it is being used presently, as a diagnostic tool for obscure gastrointestinal bleeds.