Previously, on July 4, 2025, the Department of General Surgery, People's Hospital 115 (HCMC) received patient T.T (male, 53 years old, living in Binh Thoi ward) in a state of severe anemia, prolonged black stools, and physical exhaustion. With a history of cerebral coronary artery bypass surgery, cerebral vascular accident and prolonged use of painkillers, this is a complicated case from the time of hospitalization.
Initial gas and colon endoscopy did not detect clear bleeding points. However, the patient's hemoglobin concentration continued to decrease rapidly from 6.8 to 5.6 g/dL in just a few days, raising suspicions of gastrointestinal bleeding from the small intestine, an area that was once considered the "dark area" of the digestive system, the most difficult to access and diagnose in medicine.
In response to serious progress, an urgent consultation between specialties including Gastroenterology, Endoscopy, Anesthesia and Resuscitation, I.G. Diagnosis and General Surgery was held on the morning of July 7. That same afternoon, the surgical team was activated and performed emergency surgery at 1:30 p.m., with a rare coordination strategy: both open surgery and performing endoscopy of the small intestine during surgery (Intraoperative Enteroscopy - IOE).
The surgical results showed that the 5cm long small intestine showed signs of ulcers, stiffness, and a large hanging duodenum. Thanks to the support endoscopy, the doctors discovered a 2cm wide ulcer leaking blood, located about 60cm from the angle of the duodenum. The damaged intestines are removed and safe digestive circulation is re-established.
After surgery, the patient's condition improved rapidly. After only 48 hours, the patient was alert, blood pressure was stable, self-breathing and hemoglobin levels recovered to 8.8 g/dL. This is a successful rescue thanks to the coordination between specialties in the same system.
According to experts, small intestinal bleeding is a rare but dangerous cause of gastrointestinal bleeding, often caused by NSAIDs, tumors, blood vessel malformations or Crohn's disease. Diagnose is difficult if it is only based on a regular endoscopy or catage.
In recent years, IOE technique has been recognized as a breakthrough in the diagnosis and treatment of preeclampsia. A study in Korea (Lee et al., 2021) showed that IOE helps accurately identify the source of bleeding in behind behind-the-scenes and change the treatment regimen in more than 1/3 of patients. The Brazilian report (da Silva et al., 2024) also found that IOE was absolutely effective in severe bleeding cases without complications.
