Jejunal Diverticular Bleeding on Long-Term Aspirin and Short-Term Corticosteroid Therapy

Haemorrhage is one of the most common complications of jejunal diverticula, which is a challenge to diagnose as the anatomical location of the jejunum renders it inaccessible to standard upper endoscopy, while routine imaging modalities may miss subtle or intermittent bleeding. Male gender, increasing age and colonic diverticula are known risk factors for jejunal diverticula. Nonsteroidal anti-inflammatory drugs and corticosteroids increase gastrointestinal bleeding risk. We present a case of an 80-year-old male admitted to our hospital with syncope and melaena, in the setting of colonic diverticula, long-term aspirin and short-term corticosteroid therapy. Push enteroscopy, using a paediatric colonoscope, was pivotal to establishing the diagnosis of jejunal diverticular bleeding after gastroduodenoscopy and computed tomography (CT) angiogram were negative. Management was conservative with repeat push enteroscopy confirming the cessation of bleeding. Clinicians should consider this diagnosis when there are clinical signs of gastrointestinal bleeding in patients with known risk factors for jejunal diverticula and no evidence of location on gastroduodenoscopy, colonoscopy or imaging. We advise that push enteroscopy is performed early during the diagnostic workup to assist in identifying jejunal sources of bleeding and initiating management. However, as reflected by our case, jejunal diverticular haemorrhage may be amenable to conservative measures.