Multiple duodeno-jejunal diverticula causing massive intestinal bleeding

Abstract

A case of massive intestinal blood loss from multiple duodeno-jejunal diverticula is described. A 39-year-old man was referred to our hospital because of recurrent bloody stool and worsening anemia. Upper and lower endoscopy, selective abdominal angiography, and radionuclide scanning were performed to seek the cause of the intestinal bleeding, but none of these studies revealed the source of bleeding. Small-bowel barium follow-through examination showed numerous diverticula in the distal duodenum and proximal jejunum. Excision of the duodenal diverticulum and resection of the involved portion of the jejunum cured the patient. On histopathological examination, an ulcerative lesion with an exposed vessel suggestive of the source of bleeding was seen in the resected duodenal diverticulum. Although duodeno-jejunal diverticula are rare, the importance of a careful search for this malformation in a patient with intestinal blood loss is stressed.

Jejunal diverticulae: reports of two cases with review of literature

“…Hence, a true diverticulum can either be congenital or acquired, while a false one is always acquired. JD are false, thus acquired [2,3].…”

“…Edwards noted 75% of these located in the proximal jejunum while only 5% were found in ileum [1]. Predominance of diverticulae in jejunum has been attributed to the larger caliber of vasa recta of jejunum [17,18] as JD are almost exclusively found on the mesenteric border, near the site of entry of blood vessels into the bowel wall [1,3,15,19,20].…”

“…Weakening of the bowel wall when coupled with increase in pressure inside the bowel lumen leads to development of diverticulae known as 'Pulsion diverticulae' [4,15]. Bowel wall weakening can be due to, dysfunction of smooth muscles or myenteric plexus in bowel resulting in jejunoileal dyskinesia or defect in the intestinal muscle coat [3]. Microscopic examinations of JD specimens have shown that fi brosis along with degeneration or decrease in number of normal muscle cells, or, de- generation of neurons occurring in intestinal wall underlies these dysfunctions.…”

“…He had taken treatment on the lines of gastroenteritis. Total leucocyte count was raised 3 ). An upright abdominal radiograph was normal while ultrasound did not show more than sluggish peristaltic small bowel loops.…”

“…JD are false and acquired [2,3] with a prevalence rate of 0.3-2.3% [4][5][6]. Majority of people with JD are asymptomatic or have minor, non-specifi c gastrointestinal (GI) symptoms, and found incidentally on imaging studies or exploratory laparotomy done for other reasons [3,7]. The disease is clinically signifi cant because of associated potential risk of serious complications [8].…”