Intestinal necrosis as a complication of epinephrine injection therapy during double-balloon enteroscopy.

A 77−year−old woman was admitted be− cause she had been passing tarry stools for 1 week. She had a past medical history of hypertension, coronary artery disease, and uremia requiring dialysis. Following negative upper endoscopy and colonosco− py examinations, she underwent double− balloon enteroscopy. Several blood clots were found in the jejunum and a source of active bleeding was found after 2 hours examination (Figure 1). Injection therapy with a total of 3 ml of 1 in 10 000 epineph− rine in hypertonic saline resulted in in− itial hemostasis, but the bleeding recur− red 2 days later. The patient required sur− gical intervention, when segmental ec− chymosis of the intestine was observed, 280 cm from the ileocecal valve (Figure 2). The remaining small intestine was unre− markable. Subsequent histological exami− nation revealed ischemic necrosis, invol− ving only 1.5 cm of the resected intestine, which we believed corresponded with the injection site. The patient experienced no further bleeding over a 6−month period after the operation.