[Chronic gastrointestinal bleeding of unknown cause].

Two patients with chronic gastrointestinal bleeding are reported. One patient had chronic occult bleeding with iron deficiency. Extensive evaluations performed during a period of two years in three different medical centres did not reveal the cause of the bleeding. The patient was admitted to the local hospital with acute abdominal pain. After a review of her clinical record, she was offered exploratory laparotomy. A large malignant tumour of the caecum was found. Right hemicolectomy was performed. Metastatic disease was, however, diagnosed three years later. The other patient was admitted with melena and anaemia three times during a period of two years. On the last occasion, the rectal bleeding was severe. The patient was transferred to the university medical centre. Extensive investigations did not disclose the cause of the bleeding. The cause was, however, supposed to be diverticular disease of the sigmoid colon. Laparoscopic sigmoid resection was preformed. Four weeks later the patient was once more admitted to the local hospital with severe anaemia and rectal bleeding. A formal laparotomy was performed without any further medical examinations. Ulcerations of the mucosa were found at four places in the distal part of the small intestine. Intestinal resection was performed. Diagnostic evaluation of gastrointestinal bleeding should be swift and aggressive. Modern diagnostic technology successfully identifies the cause of bleeding in 95% of patients with gastrointestinal bleeding. In highly selected patients, however, explorative surgery may still be needed as the definitive diagnostic technique.