Intraoperative Enteroscopy For The Identification Of Obscure Intestinal Bleeding Source: How I Do It

Gastrointestinal angiodysplasias (GIADs) have a wide variety of presentations, which can be significantly debilitating in a subset of patients. Intraoperative Endoscopy (IE) is a very useful tool to properly recognize the source of bleeding inside the small bowel and consequently, allow a more limited intestinal resection. The endoscope could be introduced via a transoral and/or transanal route or by a mid-small bowel enterotomy. In the former case, it could be difficult to explore all the small bowel and could require a longer procedural time. Thus, IE by a mid-small bowel enterotomy is a more direct approach to identify an obscure source of GIADs. However, this approach could be related to mucosal trauma induced by intubation and bowel manipulation. These microtraumas could be wrongly confounded with telangiectasias upon withdrawal of the endoscope. In the present video, we report a case of 91-year-old male with obscure intestinal bleeding caused by GIAD, in whom IE by enterotomy was successfully performed by using a 12mm laparoscopic trocar with balloon