Discovery and management of arteriovenous malformation with jejunal diverticulum: elusive gastrointestinal bleed

Gastrointestinal (GI) bleeds can pose significant life-threatening situations if not identified promptly, progressing to hemorrhagic shock. We discuss the case of a 60-year-old man presenting with an elusive GI bleed. Esophagogastroduodenoscopy, colonoscopy, Meckel's scan, and computed tomographic angiography were performed, which yielded no active bleed despite active hemorrhage. As a result, double-balloon computed tomography enterography was performed, demonstrating jejunal diverticula with angiodysplasia and arteriovenous malformations (AVMs), suspected to be the source of the elusive GI bleed. Clips were attempted at the sites of visible AVMs, but were unsuccessful. The diverticula were tattooed with a plan for an exploratory laparotomy for definitive treatment. The patient was ultimately discharged with no signs of active bleeding and an uncomplicated recovery. This case highlights the multifactorial management of a massive GI bleed with no identifiable source of bleeding upon admission, progressing into hemorrhagic shock.