Recurrent gastrointestinal blood loss of obscure origin: report of an exceptional case

A 66-year old tailor was admitted because of venous insufficiency of the left lower leg. During the hospital course, recurrent severe gastrointestinal blood loss developed. A classical approach was extended by enteroscopy and radionuclide scanning, followed by exploratory laparatomy with removal of two intra-abdominal sewing needles and a jejunal leiomyoma. After surgery, bleeding did not recur. This case illustrates the difficult diagnostic work-up of obscure gastrointestinal bleeding. It also shows that intra-abdominal sewing needles may migrate in the intestinal tract and remain silent during many years, eventually causing gastrointestinal bleeding.