Conference Proceeding - Restricted Access
Purpose: Jejunal diverticulosis has a reported prevalence of up to 2% on barium studies; however, it is difficult to detect prospectively and even retrospectively on computed tomography (CT). Although often asymptomatic, patients can present with hemorrhage. Bleeding diverticula occur at a rate of 2% to 8% and are amenable to endoscopic treatment, embolization, or resection. We present a case of a bleeding jejunal diverticulum, diagnosed angiographically.
Materials and Methods: A 56-year-old man presented with bright red blood per rectum and syncope. The patient was found to be anemic, and esophagogastroduodenoscopy revealed blood in the proximal jejunum without an obvious source. Interventional radiology was consulted and performed mesenteric angiography, which was negative. The patient continued to bleed with hemoglobin dropping to 5.4 g/dL despite transfusion of 15 units of packed red blood cells in 12 hours. Repeat angiogram revealed active extravasation from the second jejunal branch of the superior mesenteric artery into a jejunal diverticulum. Coil embolization of a single distal jejunal branch was performed with cessation of bleeding.
Results: After embolization, the patient was discharged. Subsequent CT enterography showed the diverticulum with adjacent coils. The patient presented 15 months later with bright red blood per rectum, and upper endoscopy revealed a bleeding jejunal diverticulum, which was resected. Gross pathology revealed a jejunal diverticulum with endovascular coils included in the specimen. The patient made a full recovery.
Conclusions: Jejunal diverticula are rare causes of lower gastrointestinal bleeding that are difficult to identify radiographically and endoscopically but should be considered in the setting of jejunal hemorrhage without an obvious cause. Careful review of angiographic images can lead to diagnosis. Coil embolization is an effective treatment. Diverticula that continue to bleed may require surgical resection for definitive management.
Savin J, Sharma J, Piziali D, Robbins JM, Ghaith G, Savin M. Jejunal diverticula, an unusual cause of upper gastrointestinal bleeding: Case report and literature review. J Vasc Interv Radiol 2021 May; 32(5): e14.