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Chung D. Jejunal diverticulosis - A case series and literature review. Ann Med Surg (Lond) 2022; 75:103477. [PMID: 35386813 PMCID: PMC8978097 DOI: 10.1016/j.amsu.2022.103477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
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2
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Kamaruddin NT, Tan JH, Teh JZ. Hidden cause of intestinal bleeding from jejunal diverticulum revealed on enteroscopy and treated successfully with segmental resection. ANZ J Surg 2021; 92:1932-1934. [PMID: 34850526 DOI: 10.1111/ans.17400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/14/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | - Jih Huei Tan
- Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Jin Zhe Teh
- Department of General Surgery, Hospital Sultan Ismail, Johor Bahru, Malaysia
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3
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Malik A, Inayat F, Goraya MHN, Almas T, Ishtiaq R, Malik S, Tarar ZI. Jejunal Dieulafoy's Lesion: A Systematic Review of Evaluation, Diagnosis, and Management. J Investig Med High Impact Case Rep 2021; 9:2324709620987703. [PMID: 33472441 PMCID: PMC7829607 DOI: 10.1177/2324709620987703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 12/17/2022] Open
Abstract
Jejunal Dieulafoy's lesion is an exceedingly rare but important cause of gastrointestinal bleeding. It frequently presents as a diagnostic and therapeutic conundrum due to the rare occurrence, intermittent bleeding symptoms often requiring prompt clinical action, variability in the detection and treatment methods, and the risk of rebleeding. We performed a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases regarding jejunal Dieulafoy's lesio from inception till June 2020. A total of 136 cases were retrieved from 76 articles. The mean age was 55 ± 24 years, with 55% of cases reported in males. Patients commonly presented with melena (33%), obscure-overt gastrointestinal bleeding (29%), and hemodynamic compromise (20%). Hypertension (26%), prior gastrointestinal surgery (14%), and valvular heart disease (13%) were the major underlying disorders. Conventional endoscopy often failed but single- and double-balloon enteroscopy identified the lesion in 96% and 98% of patients, respectively. There was no consensus on the treatment. Endoscopic therapy was instituted in 64% of patients. Combination therapy (34%) with two or more endoscopic modalities, was the preferred approach. With regard to endoscopic monotherapy, hemoclipping (19%) and argon plasma coagulation (4%) were frequently employed procedures. Furthermore, direct surgical intervention in 32% and angiographic embolization was performed in 4% of patients. The rebleeding rate was 13.4%, with a mean follow-up duration of 17.6 ± 21.98 months. The overall mortality rate was 4.4%. Jejunal Dieulafoy's lesion is still difficult to diagnose and manage. Although the standard diagnostic and therapeutic modalities remain to be determined, device-assisted enteroscopy might yield promising outcomes.
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Affiliation(s)
- Adnan Malik
- Loyola University Medical Center,
Maywood, IL, USA
| | - Faisal Inayat
- Allama Iqbal Medical College, Lahore,
Punjab, Pakistan
| | | | - Talal Almas
- Royal College of Surgeons in Ireland,
Dublin, Ireland
| | | | - Sohira Malik
- Nishter Medical University, Multan,
Punjab, Pakistan
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4
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Su HA, Hsu YC, Siao FY, Yen HH. Diagnosis and management of jejunoileal diverticular haemorrhage: An update on the experience in a single centre. PLoS One 2020; 15:e0234417. [PMID: 32574171 PMCID: PMC7310693 DOI: 10.1371/journal.pone.0234417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/25/2020] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Hsuan-An Su
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Chun Hsu
- Endoscopy Center, Changhua Christian Hospital, Changhua City, Taiwan
| | - Fu-Yuan Siao
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Hsu-Heng Yen
- Endoscopy Center, Changhua Christian Hospital, Changhua City, Taiwan
- General Education Center, Chienkuo Technology University, Changhua City, Taiwan
- College of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Taipei, Taiwan
- * E-mail:
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5
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Ko M, Yen C, Yen H. Obscure gastrointestinal bleeding with negative abdominal computed tomography study: The importance of enteroscopy for early diagnosis of small bowel malignancy. JGH Open 2020; 4:94-96. [PMID: 32055704 PMCID: PMC7008162 DOI: 10.1002/jgh3.12159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 11/11/2022]
Abstract
Small bowel tumors are rare among all gastrointestinal (GI) cancers. The most common histological subtype is adenocarcinoma. Adenocarcinoma of the small bowel is difficult to diagnose, often presents at a late stage, and has a poor prognosis. We describe a case of a patient with adenocarcinoma of the small intestine who presented to the hospital with nonspecific GI symptoms and obscure GI bleeding. An initial examination using abdominal computed tomography revealed negative findings. The patient underwent subsequent enteroscopy with capsule endoscopy and double‐balloon endoscopy, and an early‐stage jejunal adenocarcinoma was finally diagnosed.
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Affiliation(s)
- Meng‐Yu Ko
- Department of Internal MedicineChanghua Christian Hospital Changhua Taiwan
| | - Chi‐En Yen
- Department of Internal MedicineChanghua Christian Hospital Changhua Taiwan
| | - Hsu‐Heng Yen
- Division of Gastroenterology and HepatologyChanghua Christian Hospital Changhua Taiwan
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6
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Imanaliev MR, Nazhmudinov ZZ, Guseynov AG, Magomedov MA, Saidov MG. [Diverticular disease of small intestine complicated by perforation and advanced peritonitis]. Khirurgiia (Mosk) 2017:59-60. [PMID: 28745709 DOI: 10.17116/hirurgia2017759-60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- M R Imanaliev
- 'Dagestan state medical University' Ministry of health of Russia, Department of surgery, faculty training and postgraduate training of specialists, Makhachkala, Russia, 'Republican clinical hospital' Center for specialized emergency medical care, Makhachkala, Russia
| | - Z Z Nazhmudinov
- 'Dagestan state medical University' Ministry of health of Russia, Department of surgery, faculty training and postgraduate training of specialists, Makhachkala, Russia, 'Republican clinical hospital' Center for specialized emergency medical care, Makhachkala, Russia
| | - A G Guseynov
- 'Dagestan state medical University' Ministry of health of Russia, Department of surgery, faculty training and postgraduate training of specialists, Makhachkala, Russia, 'Republican clinical hospital' Center for specialized emergency medical care, Makhachkala, Russia
| | - M A Magomedov
- 'Dagestan state medical University' Ministry of health of Russia, Department of surgery, faculty training and postgraduate training of specialists, Makhachkala, Russia, 'Republican clinical hospital' Center for specialized emergency medical care, Makhachkala, Russia
| | - M G Saidov
- 'Dagestan state medical University' Ministry of health of Russia, Department of surgery, faculty training and postgraduate training of specialists, Makhachkala, Russia, 'Republican clinical hospital' Center for specialized emergency medical care, Makhachkala, Russia
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7
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Non-Meckel's Small Bowel Diverticular Bleeding: Two Case Reports and a Review of the Literature. ACG Case Rep J 2016; 3:e177. [PMID: 28008410 PMCID: PMC5171929 DOI: 10.14309/crj.2016.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/08/2016] [Indexed: 12/03/2022] Open
Abstract
Gastrointestinal bleeding from non-Meckel’s small bowel diverticulosis is uncommon. Depending on the diverticulum’s location, a patient’s presentation can suggest either an upper or lower gastrointestinal source. We present two cases of bleeding from non-Meckel’s small bowel diverticula. One patient was managed successfully with endoscopic therapy, and the second required surgical resection after two failed attempts at achieving hemostasis endoscopically.
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Abstract
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.
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Ng CH, Lee CH. Periampullary Diverticula Misdiagnosed as Cystic Pancreatic Lesions: A Review of 3 Cases. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:224-30. [PMID: 27052496 PMCID: PMC4829126 DOI: 10.12659/ajcr.896944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Case series Patient: Female, 67 • Male, 69 • Female, 65 Final Diagnosis: Periampullary diverticulum Symptoms: — Medication: — Clinical Procedure: Magnetic Resonance Imaging Specialty: Radiology
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Affiliation(s)
- Chee Hui Ng
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chau Hung Lee
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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10
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Enteroscopic Diagnosis and Management of Small Bowel Diverticular Hemorrhage: A Multicenter Report from the Taiwan Association for the Study of Small Intestinal Diseases. Gastroenterol Res Pract 2015; 2015:564536. [PMID: 26351451 PMCID: PMC4550765 DOI: 10.1155/2015/564536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/02/2015] [Indexed: 02/07/2023] Open
Abstract
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.
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11
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Moukarzel LA, Sarosiek K, Kang C, Krazwitz S, Loren D, Pucci MJ. An Approach to the Diagnosis and Treatment of Gastrointestinal Bleeding Secondary to Jejunal Diverticulosis. Am Surg 2015. [DOI: 10.1177/000313481508100302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lea A. Moukarzel
- Department of Surgery Thomas Jefferson University Hospital Philadelphia, Pennsylvania
| | - Konrad Sarosiek
- Department of Surgery Thomas Jefferson University Hospital Philadelphia, Pennsylvania
| | - Christopher Kang
- Department of Surgery Thomas Jefferson University Hospital Philadelphia, Pennsylvania
| | - Steven Krazwitz
- Department of Gastroenterology and Hepatology Thomas Jefferson University Hospital Philadelphia, Pennsylvania
| | - David Loren
- Department of Gastroenterology and Hepatology Thomas Jefferson University Hospital Philadelphia, Pennsylvania
| | - Michael J. Pucci
- Department of Surgery Thomas Jefferson University Hospital Philadelphia, Pennsylvania
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12
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Lee BJ, Kumar P, Van den Bosch R. Jejunal diverticula: a rare cause of life-threatening gastrointestinal bleeding. J Surg Case Rep 2015; 2015:rju150. [PMID: 25600131 PMCID: PMC4297890 DOI: 10.1093/jscr/rju150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Jejunal diverticula are rare and the condition remains mostly asymptomatic. However, they can present with vague chronic abdominal symptoms and, in some cases, acute life-threatening complications, such as gastrointestinal (GI) bleeding, bowel obstruction and perforation. We present a case of an adult male who presented with life-threatening GI bleeding secondary to jejunal diverticular disease. Whilst there are undoubtedly more common causes of GI bleeding, this case demonstrates that jejunal diverticular disease should remain on the differential diagnosis and investigations to confirm the diagnosis should be considered. However, despite investigations, the diagnosis may remain elusive and in patients with on-going bleeding, laparotomy and surgical resection is currently the treatment of choice.
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Affiliation(s)
- Beom Jun Lee
- Department of General Surgery, Timaru Hospital, South Canterbury, New Zealand
| | - Prashant Kumar
- Department of General Surgery, Timaru Hospital, South Canterbury, New Zealand
| | - Rene Van den Bosch
- Department of General Surgery, Timaru Hospital, South Canterbury, New Zealand
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Tanaka K, Ando K, Ueno N, Goto T, Kashima S, Inaba Y, Ito T, Moriichi K, Fujiya M, Kohgo Y. [Case report; a case of massive bleeding from jejunal diverticula completely treated by double balloon endoscopy]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2013; 102:2050-2. [PMID: 24167866 DOI: 10.2169/naika.102.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kazuyuki Tanaka
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
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Yen HH, Chen YY, Yang CW, Soon MS. Diagnosis and management of jejunoileal diverticular hemorrhage: a decade of experience. J Dig Dis 2012; 13:316-20. [PMID: 22624555 DOI: 10.1111/j.1751-2980.2012.00591.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Hsu Heng Yen
- Endoscopy Center, Department of Gastroenterology, Changhua Christian Hospital, Changhua, China.
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15
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Iwamuro M, Hanada M, Kominami Y, Higashi R, Mizuno M, Yamamoto K. Endoscopic hemostasis for hemorrhage from an ileal diverticulum. World J Gastrointest Endosc 2011; 3:154-6. [PMID: 21860685 PMCID: PMC3159504 DOI: 10.4253/wjge.v3.i7.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 04/26/2011] [Accepted: 05/15/2011] [Indexed: 02/05/2023] Open
Abstract
Hemorrhage from a non-Meckelian jejunoileal diverticulum is rare, and it is generally difficult to diagnose the source of the bleeding. Here, we report the case of a 59-year-old male with hemorrhage from an ileal diverticulum. Contrast computed tomography scans demonstrated the ileal diverticulum and extravasation of the contrast medium around it. The diagnosis was then made by computed tomography scans, and endoscopic mechanical hemostasis was performed under colonoscopy with three metal clips. The management of hemorrhage from jejunoileal diverticula is discussed.
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Affiliation(s)
- Masaya Iwamuro
- Masaya Iwamuro, Department of Internal Medicine, Hiroshima City Hospital, Hiroshima 730-8518, Japan
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Yaqub S, Evensen BV, Kjellevold K. Massive rectal bleeding from acquired jejunal diverticula. World J Emerg Surg 2011; 6:17. [PMID: 21569529 PMCID: PMC3113949 DOI: 10.1186/1749-7922-6-17] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 05/13/2011] [Indexed: 01/09/2023] Open
Abstract
Small bowel diverticulosis is an uncommon and often asymptomatic condition that is sporadically observed during radiographic examination or laparotomy. Although it is frequently seen in duodenum, jejunal and ileal locations are very rare. The majority of patients with jejunal diverticula have no symptoms. However, they can present with a number of acute and emergent complications with a high rate of mortality. Bleeding from jejunal diverticula occurs in less than 3% - 8% of patients and often present as fresh rectal haemorrhage. This can confuse the clinician since a bleeding source in colon is far more common. We report a patient with acute massive rectal bleeding. Abdominal CT angiography demonstrated a jejunal diverticulum as the bleeding source and the patient underwent resection of the affected segment. She has since remained free of gastrointestinal bleeding. Although jejunal diverticulosis is rare, it is an important differential diagnosis for patients with gastrointestinal haemorrhage of unknown origin as it may cause extensive rectal bleeding. Abdominal CT angiography can localize the bleeding source and resection of the affected bowel and primary anastomosis is the treatment of choice.
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Affiliation(s)
- Sheraz Yaqub
- Department of Gastrointestinal Surgery, Akershus University Hospital, 1478 Lørenskog, Norway.
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Falidas E, Vlachos K, Mathioulakis S, Archontovasilis F, Villias C. Multiple giant diverticula of the jejunum causing intestinal obstruction: report of a case and review of the literature. World J Emerg Surg 2011; 6:8. [PMID: 21385440 PMCID: PMC3061903 DOI: 10.1186/1749-7922-6-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 03/08/2011] [Indexed: 01/12/2023] Open
Abstract
Multiple diverticulosis of jejunum represents an uncommon pathology of the small bowel. The disease is usually asymptomatic and must be taken into consideration in cases of unexplained malabsorption, anemia, chronic abdominal pain or discomfort. Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction appear in 10-30% of the patients increasing morbidity and mortality rates. We herein report a case of a 55 year-old man presented at the emergency department with acute abdominal pain, vomiting and fever. Preoperative radiological examination followed by laparotomy revealed multiple giant jejunal diverticula causing intestinal obstruction. We also review the literature for this uncommon disease.
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Affiliation(s)
- Evangelos Falidas
- First Department of General Surgery, 417 NIMTS, Veterans Hospital of Athens, 10-12 Monis Petraki, 11521, Athens, Greece
| | - Konstantinos Vlachos
- First Department of General Surgery, 417 NIMTS, Veterans Hospital of Athens, 10-12 Monis Petraki, 11521, Athens, Greece
| | - Stavros Mathioulakis
- First Department of General Surgery, 417 NIMTS, Veterans Hospital of Athens, 10-12 Monis Petraki, 11521, Athens, Greece
| | - Fotis Archontovasilis
- First Department of Therapeutic Endoscopy and Laparoscopic Surgery, Iaso General Hospital, 264 Mesogion Avenue, 15562, Cholargos, Greece
| | - Constantinos Villias
- First Department of General Surgery, 417 NIMTS, Veterans Hospital of Athens, 10-12 Monis Petraki, 11521, Athens, Greece
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Yen HH, Chen YY, Yang CW, Soon MS. The clinical significance of jejunal diverticular disease diagnosed by double-balloon enteroscopy for obscure gastrointestinal bleeding. Dig Dis Sci 2010; 55:3473-8. [PMID: 20397046 DOI: 10.1007/s10620-010-1211-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 03/21/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND Jejunal diverticular disease is a rare cause of gastrointestinal bleeding. The reported incidence of this disease is low in the studies of double-balloon enteroscopy. AIM The aim of this study was to evaluate the clinical features and management of jejunal diverticular disease, diagnosed by double-balloon enteroscopy, at our institution. METHOD This was a retrospective study of patients with jejunal diverticular disease conducted from April 2004 to September 2009 at Changhua Christian Hospital. We evaluated the clinical significance of jejunal diverticular disease and the outcome of endoscopic treatment for jejunal diverticular bleeding. RESULTS From April 2004 to September 2009, a total of 55 patients underwent double-balloon enteroscopy due to obscure gastrointestinal bleeding. Fifteen of these patients were diagnosed with jejunal diverticular disease (8 men and 7 women, mean age 71 years). Four patients were found to have a single diverticulum. Gastrointestinal bleeding was attributed to jejunal diverticular disease in 12 patients. Six patients received endoscopic treatment in order to achieve hemostasis. One patient received emergency surgery due to uncontrolled bleeding. CONCLUSIONS To our knowledge, this is the first study reporting the clinical significance of jejunal diverticular disease diagnosed by double-balloon enteroscopy. We found that obscure GI bleeding was attributed significantly to jejunal diverticular disease.
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Affiliation(s)
- Hsu-Heng Yen
- Endoscopy Center, Department of Gastroenterology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan.
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19
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Chen TH, Chiu CT, Lin WP, Su MY, Hsu CM, Chen PC. Application of double-balloon enteroscopy in jejunal diverticular bleeding. World J Gastroenterol 2010; 16:5616-20. [PMID: 21105196 PMCID: PMC2992681 DOI: 10.3748/wjg.v16.i44.5616] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.
METHODS: From January 2004 to September 2009, 154 patients underwent double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding. Ten consecutive patients with jejunal diverticula (5 males and 5 females) at the age of 68.7 ± 2.1 years (range 19-95 years) at Chang Gung Memorial Hospital, Academic Tertiary Referral Center, were enrolled in this study.
RESULTS: Of the 10 patients, 5 had melena, 2 had hematochezia, 2 had both melena and hematochezia, 1 had anemia and dizziness. DBE revealed ulcers with stigmata of recent hemorrhage in 6 patients treated by injection of epinephrine diluted at 1:10 000, Dieulafoy-like lesions in 4 patients treated by deploying hemoclips on the vessels, colonic diverticula in 2 patients, and duodenal diverticula in 3 patients, respectively. Of the 2 patients who underwent surgical intervention, 1 had a large diverticulum and was referred by the surgeon for DBE, 1 received endoscopic therapy but failed due to massive bleeding. One patient had a second DBE for recurrent hemorrhage 7 mo later, which was successfully treated with a repeat endoscopy. The mean follow-up time of patients was 14.7 ± 7.8 mo.
CONCLUSION: DBE is a safe and effective treatment modality for jejunal diverticular bleeding.
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ArterioVenous Malformation within Jejunal Diverticulum: an unusual cause of massive gastrointestinal bleeding. Gastroenterol Res Pract 2009; 2009:384506. [PMID: 19753317 PMCID: PMC2742646 DOI: 10.1155/2009/384506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 08/06/2009] [Indexed: 12/24/2022] Open
Abstract
Massive gastrointestinal (GI) bleeding can occur with multiple jejunal diverticulosis. However, significant bleeding in the setting of few diverticulae is very unusual and rare. We report a case of massive gastrointestinal bleeding from an arteriovenous malformation (AVM) within a jejunal diverticulum to underscore the significance of such coexisting pathologies. Mesenteric angiogram was chosen to help identify the source of bleeding and to offer an intervention. Despite endovascular coiling, emergent intestinal resection of the bleeding jejunal segment was warranted to ensure definitive treatment. However several reports have shown jejunal diverticulosis as a rare cause of massive GI bleeding. The coexistence of jejunal diverticulum and AVM is rare and massive bleeding from an acquired Dieulafoy-like AVM within a diverticulum has never previously been described. Awareness of Dieulafoy-like AVM within jejunoileal diverticulosis is useful in preventing delay in treatment.
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