Successful diagnosis and treatment of jejunal diverticular haemorrhage by full-thickness enterotomy: A case report

Abstract

BACKGROUND

Jejunal diverticula are the rarest of all small bowel diverticula and usually have no classic clinical symptoms. Jejunal diverticular haemorrhage (JDH) is a rare complication and can be difficult to identify and manage, hence it always resulting in a diagnostic delay and unsatisfactory clinical outcomes. Although with the advances in endoscopic technology, no consensus have been reached on the diagnosis and management of JDH, the conventional surgical intervention still remains the mainstream for the management of JDH. We report an unique case of a 63-year-old male who presented with massive haemorrhage from jejunal diverticula, which was successfully managed by initial resuscitation and definitive surgery.

CASE SUMMARY

A 63-year-old male was admitted as an emergency with 6 h history of haematemesis and melena. The haematemesis appeared to be bright red, with volume exceeding 100 mL. The amount of melena was estimated to be 200 mL. Initially, the patient received fluid resuscitation and three unit blood transfusion. Then, in order to localize the bleeding sites, colonoscopy, upper gastrointestinal endoscopy, and mesenteric angiography were utilized but failed to identify the source of haemorrhage. Informed consent form was obtained for further treatment, and he was treated with an exploratory laparotomy and the bleeding site was successfully located during the procedure. He was diagnosed with JDH. The postoperative period was uneventful, and he was discharged on day 18 after surgery. No rebleeding occurred at the 1-year follow-up.

CONCLUSION

In patients with gastrointestinal bleeding, if various techniques fail to identify the cause of haemorrhage in small bowel and haemodynamic instability is sustained with continuous resuscitation, we recommend surgical intervention should be the ultimate treatment of choice.

Keywords: Case report; Jejunal diverticular haemorrhage; Colonoscopy; Gastrointestinal bleeding; Surgical intervention

Core Tip: In patients with gastrointestinal bleeding, if all methods have failed to identify the cause of haemorrhage in small bowel and haemodynamic instability sustains with continuous resuscitation, we recommend surgical intervention as the ultimate treatment of choice for jejunal diverticular haemorrhage. Surgeons should strictly follow the diagnosis and treatment guidelines of acute gastrointestinal bleeding and have a better understanding of the strengths and weaknesses of various techniques, which would be extremely helpful for selecting the optimal clinical pathways and conducting multidisciplinary collaboration accurately and quickly.