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Lucaciu LA, Skamnelos A, Murino A, Lazaridis N, Chacchi Cahuin R, Raymond R, Despott EJ. Life-threatening small-bowel diverticular bleed treated by double-balloon enteroscopy in a patient refusing transfusion. Endoscopy 2024; 56:E69. [PMID: 38262460 PMCID: PMC10805611 DOI: 10.1055/a-2224-7759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Laura A. Lucaciu
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Alexandros Skamnelos
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Alberto Murino
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Rocio Chacchi Cahuin
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Regina Raymond
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Edward J. Despott
- Royal Free Unit for Endoscopy, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
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2
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Vacharathit V, Siranart N, Prueksapanich P, Manasnayakorn S. Occult bleeding from a false-in-true non-Meckelian ileal diverticulum. BMJ Case Rep 2024; 17:e257063. [PMID: 38182170 PMCID: PMC10773406 DOI: 10.1136/bcr-2023-257063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
Ileal diverticula can be congenital or acquired and are rare even among the already rare entity of small bowel diverticula. What has never been reported, as far as we know, is false diverticula arising within the true non-Meckelian diverticulum with mesenteric erosion causing an occult gastrointestinal bleed. We present a patient with occult gastrointestinal bleeding from a false-in-true ileal diverticulum. Multiple investigations were required to localise the bleeding site after which the patient was taken to the operating room for a laparoscopic ileocaecectomy with complete resolution of symptoms. Preoperative localisation of the bleeding site may be difficult but is critically important in occult gastrointestinal bleeding. Procedure choice for a bleeding ileal diverticulum is dictated by the distance from the ileocaecal valve and the etiopathology of the bleed.
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Affiliation(s)
- Voranaddha Vacharathit
- Faculty of Medicine, Department of Surgery, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Chulalongkorn University, Bangkok, Thailand
| | - Noppachai Siranart
- Faculty of Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Chulalongkorn University, Bangkok, Thailand
| | - Piyapan Prueksapanich
- Faculty of Medicine, Department of Medicine, Division of Gastroenterology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Chulalongkorn University, Bangkok, Bangkok, Thailand
| | - Sopark Manasnayakorn
- Faculty of Medicine, Department of Surgery, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Chulalongkorn University, Bangkok, Thailand
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Pérez-Cuadrado Robles E, Pinho R, González-Suárez B, Mão-de-Ferro S, Chagas C, Esteban Delgado P, Carretero C, Figueiredo P, Rosa B, García-Lledó J, Nogales Ó, Ponte A, Andrade P, Juanmartiñena-Fernández JF, San-Juan-Acosta M, Lopes S, Prieto-Frías C, Egea Valenzuela J, Caballero N, Valdivieso-Cortázar E, Cardoso H, Gálvez C, Almeida N, Borque Barrera P, Gómez Rodríguez BJ, Sánchez Ceballos FL, Bernardes C, Alonso-Aguirre PA, Argüelles Arias F, Mascarenhas Saraiva M, Pérez-Cuadrado Martínez E. Small bowel enteroscopy - A joint clinical guideline by the Spanish and Portuguese small-bowel study groups. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:309-318. [PMID: 32188259 DOI: 10.17235/reed.2020.7020/2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small-bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication, and its diagnostic and therapeutic yield. A set of recommendations was issued accordingly.
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Affiliation(s)
| | - Rolando Pinho
- Gastroenterología, Centro Hospitalar de Vila Nova de Gaia e Espinho, Portugal
| | | | - Susana Mão-de-Ferro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa. E.P.E., Portugal
| | | | | | | | - Pedro Figueiredo
- Gastroenterology , Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Bruno Rosa
- Gastroenterology, Hospital Senhora da Oliveira, Portugal
| | | | - Óscar Nogales
- Aparato Digestivo, Hospital General Universitario Gregorio Marañón, España
| | - Ana Ponte
- Centro Hospitalar Vila Nova de GaiaEspinho, Portugal
| | | | | | | | - Sandra Lopes
- Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Portugal
| | | | | | - Noemí Caballero
- Gastrointestinal Endoscopy, Hospital Universitario Germans Trias i Pujol, Spain
| | | | | | - Consuelo Gálvez
- Gastroenterología, Hospital Clínico Universitario de Valencia, Spain
| | - Nuno Almeida
- Gastroenterology , Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Pilar Borque Barrera
- Aparato Digestivo. Unidad de Endoscopia, Hospital Universitario Nuestra Sra. de Candelaria, España
| | | | | | - Carlos Bernardes
- Gastroenterology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Portugal
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4
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Goh B, Harbison A, Sufyan W, Thomas S. Perforated jejunal diverticular disease: an uncommon cause of the acute surgical abdomen. ANZ J Surg 2021; 91:E608-E609. [PMID: 33497515 DOI: 10.1111/ans.16618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/21/2020] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Barnabas Goh
- Department of General Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Annabelle Harbison
- Department of General Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Wajiha Sufyan
- Department of General Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sabu Thomas
- Department of General Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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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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Pérez-Cuadrado-Robles E, Pinho R, Gonzalez B, Mão de Ferro S, Chagas C, Esteban Delgado P, Carretero C, Figueiredo P, Rosa B, García Lledó J, Nogales Ó, Ponte A, Andrade P, Juanmartiñena-Fernández JF, San-Juan-Acosta M, Lopes S, Prieto-Frías C, Egea-Valenzuela J, Caballero N, Valdivieso-Cortazar E, Cardoso H, Gálvez C, Almeida N, Borque Barrera P, Gómez-Rodríguez BJ, Sánchez Ceballos F, Bernardes C, Alonso P, Argüelles-Arias F, Mascarenhas Saraiva M, Pérez-Cuadrado-Martínez E. Small Bowel Enteroscopy - A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:324-335. [PMID: 32999905 DOI: 10.1159/000507375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022]
Abstract
The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.
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Affiliation(s)
| | - Rolando Pinho
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Begoña Gonzalez
- Department of Gastroenterology. Endoscopy Unit, ICMDiM, Hospital Clínic, Barcelona, Spain
| | - Susana Mão de Ferro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
| | - Cristina Chagas
- Department of Gastroenterology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | - Cristina Carretero
- Department of Gastroenterology, University of Navarra Clinic, Pamplona, Spain
| | - Pedro Figueiredo
- Gastroenterology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Bruno Rosa
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Javier García Lledó
- Department of Gastroenterology, Endoscopy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Óscar Nogales
- Department of Gastroenterology, Endoscopy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Ponte
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Patrícia Andrade
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | | | - Mileidis San-Juan-Acosta
- Department of Gastroenterology, Gastrointestinal Endoscopy Unit, Hospital Universitario Nuestra Señora de Candelaria, Candelaria, Tenerife, Spain
| | - Sandra Lopes
- Gastroenterology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - César Prieto-Frías
- Department of Gastroenterology, University of Navarra Clinic, Pamplona, Spain
| | - Juan Egea-Valenzuela
- Unit of Gastrointestinal Endoscopy, Department of Digestive Disease, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Noemí Caballero
- Department of Gastrointestinal Endoscopy, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | | | - Hélder Cardoso
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - Consuelo Gálvez
- Department of Gastroenterology. Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Nuno Almeida
- Gastroenterology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Pilar Borque Barrera
- Department of Gastroenterology, Gastrointestinal Endoscopy Unit, Hospital Universitario Nuestra Señora de Candelaria, Candelaria, Tenerife, Spain
| | - Blas José Gómez-Rodríguez
- Department of Gastroenterology, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | | | - Carlos Bernardes
- Department of Gastroenterology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Pedro Alonso
- Department of Gastroenterology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Federico Argüelles-Arias
- Department of Gastroenterology, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
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Koh FJ, Khor JL, Chew MH. An unusual case of giant ileal diverticulum-A case report. Int J Surg Case Rep 2017; 41:277-279. [PMID: 29126072 PMCID: PMC5683754 DOI: 10.1016/j.ijscr.2017.10.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/14/2017] [Accepted: 10/22/2017] [Indexed: 12/25/2022] Open
Abstract
Large ileal diverticula are extremely rare and bleeding complications can result in high overall mortality. Small bowel diverticulosis though uncommon has to be considered during workup for obscure gastrointestinal bleeding. Endoscopic treatment for small bowel diverticular bleeding is an alternative approach that can be considered for high-risk patients.
Small bowel diverticulosis is rare with an incidence of 1–2% in the general population. It is an uncommon cause of gastrointestinal bleeding that ranges from obscure to overt bleeding. Large ileal diverticula are extremely rare and bleeding complications can result in high overall mortality. A young gentleman presented with persistent per-rectal bleeding and drop in hemoglobin level. He was recently diagnosed with acute myeloid leukemia and was undergoing chemotherapy. A computed tomography scan of the abdomen and pelvis revealed a giant ileal diverticulum. In view of on-going bleeding, he underwent double balloon enteroscopy which revealed active bleeding from an ulcer within the giant ileal diverticulum and successful hemostasis was performed with hemostatic clips. Small bowel diverticulosis though uncommon has to be considered during workup for gastrointestinal bleeding. Endoscopic treatment is a modern approach towards small bowel diverticular bleeding that is effective and less invasive.
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Affiliation(s)
- Fang Ju Koh
- Department of Colorectal Surgery, Singapore General Hospital, 1 Hospital Drive, Singapore
| | - Jen Lock Khor
- Department of Gastroenterology, Singapore General Hospital, 1 Hospital Drive, Singapore
| | - Min Hoe Chew
- Department of Colorectal Surgery, Singapore General Hospital, 1 Hospital Drive, Singapore.
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Chen BC, Chen PJ, Shih YL, Huang HH, Lin XH, Lin JC, Tseng YC, Chen CT, Hsu CH, Chang WK, Hsieh TY, Huang TY. Single-balloon enteroscopy for managing obscure gastrointestinal bleeding: Results from a tertiary medical center in Taiwan. ADVANCES IN DIGESTIVE MEDICINE 2017. [DOI: 10.1002/aid2.12018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Bao-Chung Chen
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Peng-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Xuan-Huai Lin
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Jung-Chun Lin
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Yu-Chen Tseng
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Chun-Ting Chen
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Chin-Hui Hsu
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
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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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