Massive Gastrointestinal Bleeding Due to Jejunal Diverticula in a Community Hospital: A Case Report and Review of Diagnostic and Therapeutic Options

Cynthia Abbasi,Michael Lisi,M Carolina Jimenez

doi:10.3390/gastroent12020017

Abstract

Small bowel diverticula are rare and often asymptomatic. Severe lower gastrointestinal bleeding from jejunal diverticula is rarely reported and, therefore, should be considered a differential diagnosis in all cases of lower gastrointestinal bleeding with nonconclusive gastroscopy and colonoscopy. In this case report, we discuss a case of a 75-year-old male with massive lower gastrointestinal bleeding from jejunal diverticula. Initial gastroscopy did not reveal the source of bleeding. Repeat upper endoscopy with a pediatric colonoscope identified jejunal diverticula as the likely source of bleeding. Angiography identified the site of extravasation, and successful angioembolization was done by interventional radiology.

Highlights

Acute gastrointestinal bleeding is a medical emergency that contributes to the patient’s morbidity and mortality [1]
Due to difficulty accessing the small bowel via endoscopy, establishing a diagnosis can be delayed
Small intestinal diverticula usually occur on the mesenteric side of the bowel, where where increased intraluminal pressure leads to the protrusion of mucosa through defects defects in in the the lamina muscularis[4,5,6,7]

Summary

Introduction

Acute gastrointestinal bleeding is a medical emergency that contributes to the patient’s morbidity and mortality [1]. Severe gastrointestinal bleeding secondary to small bowel diverticula is rare. Bleeding due to jejunal diverticula is even rarer and accounts for up to 2.3 percent of individuals in radiographic series and 7 percent in autopsy studies [2,3]. The majority of patients with jejunal diverticulosis are asymptomatic. Patients can present with complications such as bleeding, perforation or abscess. Due to difficulty accessing the small bowel via endoscopy, establishing a diagnosis can be delayed. In this case report, we discuss a case of a 75-year-old man with massive lower gastrointestinal bleeding from jejunal diverticula and highlight the diagnostic evaluations and treatment involved.

Case Report

Findings

Discussion

Conclusions