Differential Diagnosis for Small Bowel Bleeding in Adults

• Single most likely diagnosis
  • (b) arteriovenous malformation: This is considered the most common cause of small bowel bleeding in adults. Arteriovenous malformations (AVMs) are vascular lesions that can cause bleeding due to the abnormal connection between arteries and veins, leading to vessel wall weakness and potential rupture.
• Other Likely diagnoses
  • (a) Crohn’s disease: A type of inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract, including the small bowel, leading to inflammation, ulcers, and potentially bleeding.
  • (d) Meckel’s diverticulum: A congenital anomaly of the small intestine that can contain ectopic tissue, such as gastric or pancreatic tissue, which can lead to bleeding, especially in younger adults.
• Do Not Miss diagnoses
  • (e) carcinoid neoplasms: Although less common, carcinoid tumors can cause bleeding and have a potential for malignancy. Missing this diagnosis could lead to delayed treatment of a potentially serious condition.
  • (c) leiomyosarcoma: A rare but malignant tumor of the smooth muscle in the small bowel wall. While rare, it is crucial not to miss this diagnosis due to its potential for aggressive behavior and poor prognosis if not treated early.
• Rare diagnoses
  • Other rare causes of small bowel bleeding include vascular ectasias, Dieulafoy’s lesion, and small bowel varices, among others. These conditions are less common but should be considered in the differential diagnosis, especially if common causes have been ruled out.