Massive rectal bleeding from acquired jejunal diverticula

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.

Rare Jejunal Diverticular Bleeding

“…Much rarer findings are a congenital (true) diverticulum in jejunum or small bowel duplication (mimics small bowel diverticulum) 2,4. Eighty percent of small bowel diverticulosis occurs in the jejunum, 15% in the ileum, and 5% in both 4,5. The condition is associated with colonic diverticular lesions in 50%-75% of cases, with duodenal diverticula in 25.9% of cases, and with esophageal lesions in 2.3% of cases 2.…”

“…The condition is associated with colonic diverticular lesions in 50%-75% of cases, with duodenal diverticula in 25.9% of cases, and with esophageal lesions in 2.3% of cases 2. Jejunal diverticula are typically asymptomatic; however, severe complications are seen in 10%-30% of patients 5. These complications include hemorrhage, small bowel perforation, malabsorption, volvulus, enterolith formation, abscess, diverticulitis, and intestinal obstruction 2-6…”

“…Bleeding from JD is seen in 3.4%-8.1% and can result in massive GIB 5. In 1923, Dr. L. R. Braithwaite, a British surgeon, was the first to report a case of bleeding from JD 6.…”

Perforated Jejunal Diverticulosis: Report of a Case and Review of the Literature

“…Complications of jejunal diverticulosis warranting surgical intervention occur in 10-30% of patients and the most common acute complications include diverticulitis, bleeding, enterolith formation, intestinal obstruction and perforation [16][17][18], however, some patients respond to the temporary interruption of the enteral nutrition, to a gastrointestinal relief with a nasogastric tube and to the administration of empirical, wide-spectrum antibiotics [19,20]. Another series of perforated diverticulitis treated conservatively with antibiotic administration and CT-guided drainage of abdominal abscesses have also been presented [21].…”

Complicated small bowel diverticular disease: a case series

“…Diverticular disease of the colon is a common affliction of the elderly 1. However, diverticula of the small bowel are extremely uncommon, and though their aetiology has not been completely explained, it is thought that they are often acquired 2.…”