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Introduction Small Bowel (SB) Bleeding is one of the common gastrointestinal problems, particularly in elders. The study aimed to find the causes of refractory bleeding and overcome the challenges and difficulties of surgical treatment for SB refractory bleeding. Methods All Patients with SB refractory bleeding who underwent surgical treatment were included in this study. Patients’ characteristics, surgical finding, and follow-up assessments were reviewed and analyzed through Hospital Information System (HIS) records from October 1st ,2014, to November 30th ,2020. All analyses were performed using SPSS v23.0. Results The causes of SB bleeding include Vascular lesions (Angioectasia, AVM, Dieulafoy lesions) 29.6%, Tumors (Polyps, GIST, Adenocarcinoma, and other) 24.5%, Diverticular 18.4%, Ulcers/erosion 15.3%, Inflammatory bowel disease 7.1% and other 5.1%. Patients (age |