Massive hemorrhage from jejunal diverticula

Area of Science:

• Gastroenterology
• Interventional Radiology

Background:

• Jejunal diverticula are an uncommon source of massive gastrointestinal bleeding.
• Bleeding often presents as lower gastrointestinal hemorrhage, mimicking other conditions.

Observation:

• Three patients presented with life-threatening rectal hemorrhage due to bleeding jejunal diverticula.
• Angiography successfully localized the bleeding source in all patients.
• Vasopressin infusion was ineffective for hemostasis in two patients.

Findings:

• Jejunal diverticula can cause significant lower GI bleeding.
• Angiographic localization is crucial for surgical planning due to the occult nature and proximal location of these diverticula.
• A normal small intestine series does not rule out jejunal diverticula as a bleeding source.

Implications:

• Early diagnosis and precise localization via angiography are vital for managing massive GI bleeding from jejunal diverticula.
• Surgical intervention may be necessary when less invasive methods fail.
• Clinicians should consider jejunal diverticula in the differential diagnosis of obscure massive lower GI bleeding.