[Acute gastrointestinal bleeding caused by distinct small intestinal diverticulosis]

Area of Science:

• Gastroenterology
• Digestive Diseases

Background:

• Gastrointestinal hemorrhage is a frequent cause for hospital admission.
• Recurrent duodenal ulcer disease increases the risk of gastrointestinal bleeding.

Observation:

• A 58-year-old male presented with acute rectal bleeding and a history of duodenal ulcers.
• Nasogastric lavage revealed blood; upper endoscopy showed minor gastric erosions, and colonoscopy revealed diverticula.
• Small bowel enteroclysis identified severe duodenojejunal diverticulosis.

Findings:

• Duodenojejunal diverticulosis was identified as the likely cause of bleeding, given simultaneous upper and lower gastrointestinal hemorrhage signs.
• A conservative management strategy was chosen due to the patient being hemodynamically stable and this being the first bleeding episode.
• No recurrence of bleeding was observed during a 19-month follow-up period.

Implications:

• Small bowel diverticula are a potential, albeit rare, cause of gastrointestinal bleeding that should be considered after excluding more common sources.
• While surgical resection is the primary treatment for bleeding diverticula, precise localization can be challenging.
• A conservative approach is a viable option for hemodynamically stable patients experiencing their first episode of diverticular bleeding, especially when the bleeding site is not definitively located.