The clinical significance of jejunal diverticular disease diagnosed by double-balloon enteroscopy for obscure gastrointestinal bleeding

Variability in the presentation of complicated jejunal diverticulosis

Jejunal diverticulosis is a rare disease which normally presents for the first time with acute complications, often requiring surgical intervention. The diverticulae are acquired, occurring more commonly after middle age, but their aetiology is unclear. We discuss this condition in the context of four cases which presented to our hospital as emergencies over a five year period: small bowel obstruction, gastrointestinal haemorrhage, small bowel volvulus, and visceral perforation. Our aim is to encourage clinicians to include jejunal diverticular disease as a differential diagnosis in patients with abdominal symptoms.

Diagnosis and management of jejunoileal diverticular haemorrhage: An update on the experience in a single centre

INTRODUCTION

Jejunoileal diverticular haemorrhage is a rare disease that is difficult to diagnose and treat. Despite advances in endoscopic technology, recommendations on diagnosis and management for jejunoileal diverticular haemorrhage have remained unchanged and these new options have not been compared against traditional surgical management.

MATERIALS AND METHODS

We retrospectively reviewed the diagnosis, management, and outcome for jejunoileal diverticular haemorrhage cases at our institution over the past 20 years. Data were organized and analysed by chi-square test, student t-test and Kaplan-Meier survival analysis.

RESULTS

The most utilised diagnostic procedure was computed tomography, followed by enteroscopy, angiography, small bowel flow-through and surgery. Primary treatments included, in a decreasing order, medical therapy, surgery, endoscopy and radiology. Surgical treatment was not associated with rebleeding, but it did result in longer hospital stays and larger blood transfusions than non-surgical treatments. The bleeding-related mortality rate was very low. Notably, there was also little change in the diagnosis and treatment between decades.

CONCLUSION

We presented our experience with the diagnosis and management of jejunoileal diverticular haemorrhage, as well as long-term follow-up after treatments that have not been reported previously. Surgical treatment continues to dominate management for jejunoileal diverticular haemorrhage, but we support increasing the role of endoscopy for select patient groups.

A Rare Presentation of Small Bowel Diverticulosis Causing Chronic Obstruction and Malnutrition: A Case Study with Review of Literature

Small bowel diverticulosis is an uncommon entity. Clinical presentation of small intestinal diverticulosis is variable. A high mortality is associated with complications such as chronic malnutrition, haemorrhage, intestinal obstruction, and perforation. We report a case of a 63-year-old female with multiple small bowel diverticuli spanning from the first part of the duodenum to the proximal ileum presenting with chronic malnutrition and subacute intestinal obstruction. Although exploratory laparotomy was performed, we opted for a totally conservative treatment in order to avoid complications such as short gut syndrome and anastomotic leakage.

Small intestinal diverticulum with bleeding: Case report and literature review

RATIONALE

Small intestinal diverticulum with bleeding is an important reason for obscure gastrointestinal bleeding (OGB) , in addition to tumor and vascular diseases. Small intestinal diverticulum with bleeding is difficult to detect by barium meal and angiographic methods and has been regarded as an important cause of obscure gastrointestinal tract bleeding in adolescents. Because of its complicated etiology and non-specific clinical manifestations, it is relatively difficult to detect small intestinal diverticulum with bleeding, especially in patients with a large amount of bleeding and hemodynamic instability.

PATIENT CONCERNS

This retrospective study collects clinical statistics of 19 patients admitted to our hospital from January 2010 to December 2016. Patients who had small intestinal diverticulum patients with bleeding were included in this study. Patients who were taking anticoagulants were excluded DIAGNOSES:: Small intestinal diverticulum patients with bleeding.

INTERVENTIONS

This retrospective study describes the clinical features of patients with small intestinal diverticulum whose main symptom was gastrointestinal bleeding and analyze the literature on this topic, with particular reference to the clinical characteristics, pathological features, and choice of examination methods.

LESSONS

Small intestinal diverticulum with bleeding is a common cause of obscure gastrointestinal bleeding, but it is difficult to detect using normal examination methods. For patients with repeated gastrointestinal bleeding and no positive results found on gastroscopy and colonoscopy, endoscopy of the small intestine and CTE with contrast can be considered as a diagnostic modality.

Rare Jejunal Diverticular Bleeding

Severe gastrointestinal bleeding (GIB) secondary to jejunal diverticulosis (JD) is very rare. Delay in establishing a diagnosis is common and GIB from JD is associated with significant morbidity and mortality. We report an illustrative case diagnosed by push enteroscopy and managed with surgery.

Enteroscopic Diagnosis and Management of Small Bowel Diverticular Hemorrhage: A Multicenter Report from the Taiwan Association for the Study of Small Intestinal Diseases

Small bowel diverticulum is a rare cause of gastrointestinal bleeding. The diagnosis and treatment of small bowel diverticular hemorrhage is clinically challenging before the development of deep enteroscopy. In this multicenter study from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID), 608 patients underwent deep enteroscopy for obscure gastrointestinal bleeding during January 2004 and April 2010 from eight medical centers in Taiwan. Small bowel diverticular hemorrhage account for 7.89% of obscure gastrointestinal bleeding in this study. Most of the patients received endoscopic therapy with an initial hemostasis rate of 85.71% and rebleeding rate of 20%. In this large case series investigating the enteroscopic management of small intestinal diverticular hemorrhage, we found that, as to patients with peptic ulcer hemorrhage, most of these patients can be successfully managed by endoscopic therapy before surgery in the era of deep enteroscopy.

Diagnosis and management of jejunoileal diverticular hemorrhage: a decade of experience

OBJECTIVE

The aim of this study was to evaluate the clinical features and management of jejunoileal diverticular hemorrhage at Changhua Christian Hospital over the past decade.

METHODS

A retrospective study on the clinical features, treatment and outcomes of the patients with jejunoileal diverticular hemorrhage diagnosed from January 2000 to December 2010 was conducted.

RESULTS

Twenty-eight patients (male to female ratio 15:13) were enrolled in the study with a mean age of 73.9 years. Symptoms consisted of bloody stool (46.4%), tarry stool (82.1%), coffee ground vomitus (7.1%) and shock (39.3%). The mean duration of hospital stay was 13.5 days and the mean blood transfusion volume was 13.5 units. Eight patients (28.6%) underwent surgical resection, 9 (32.1%) received endoscopic therapy and 11 (39.3%) were administered conservative therapy. Five patients (17.9%) had recurrent bleeding during the follow-up. Two patients (7.1%) died eventually.

CONCLUSIONS

The management of jejunoileal diverticular hemorrhage has mainly been nonsurgical at our institution over the past decade. The decreased requirement of surgical intervention might be attributed to the improvement of diagnostic and treatment procedures during this period.

Clinical impact of multidetector computed tomography before double-balloon enteroscopy for obscure gastrointestinal bleeding

AIM: To evaluate the clinical impact of multidetector computed tomography (MDCT) before double-balloon endoscopy (DBE) for patients with obscure gastrointestinal bleeding (OGIB).

METHODS: A retrospective analysis of prospectively collected cases with DBE and MDCT for overt OGIB was conducted from April 2004 to April 2010 at Changhua Christian Hospital. We evaluated the clinical impact of MDCT on the subsequent DBE examinations and the diagnostic yields of both MDCT and DBE respectively.

RESULTS: From April 2004 to April 2010, a total of 75 patients underwent DBE for overt OGIB. Thirty one cases received MDCT followed by DBE for OGIB. The overall diagnostic yields of DBE and MDCT was 93.5% and 45.2%. The MDCT had a high diagnostic yield of tumor vs non-tumor etiology of OGIB (85.7% vs 33.3%, P = 0.014). Additionally, the choice of initial route of DBE was correct in those with a positive MDCT vs negative MDCT (100% vs 52.9%, P = 0.003).

CONCLUSION: This study suggests MDCT as a triage tool may identify patients who will benefit from DBE and aid the endoscopist in choosing the most efficient route.