J Korean Surg Soc.  2002 Dec;63(6):513-516.

Massive Bleeding from Jejunal Diverticulosis with an Angiodysplasia in a Patient with End Stage Renal Disease

• Lee JH
• Kim W
• Kim JS
• Jeon HM

Abstract

Small bowel diverticulum, although not common and usually asymptomatic, can give rise to unexpected problems such as malabsorption, perforation, obstruction and bleeding. Bleeding from a diverticulum is often sudden and massive, therefore requiring emergency operation. We report herein a case of a 75-year-old man who presented with massive bleeding from multiple jejunal diverticula. He had been diagnosed with hypertensive end stage renal disease and treated with hemodialysis since 14 years previously. He was admitted with both hematemesis and hematochezia, and treated conservatively at first. However, bleeding continued and the anemia did not improve despite blood transfusions. An gastroduodenofiberscope and selected angiography revealed no bleeding focus. An emergency laparotomy was performed and multiple jejunal diverticula, distributed from 15 to 60cm distal to the ligament of Treitz, were found. A segment of the jejunum containing all diverticula was resected and end to end anastomosis was performed. A histologic examination revealed some dilated blood vessels in the submucosa of the diverticulum, which was compatible with the findings of the angiodysplasia. Based on these findings, we suggest that angiodysplasia was the cause of bleeding from the jejunal diverticula in this case.

Keyword

Jejunal diverticulosis; Angiodysplasia; Massive bleeding; End stage renal disease

MeSH Terms

Aged
Anemia
Angiodysplasia*
Angiography
Blood Transfusion
Blood Vessels
Diverticulum*
Emergencies
Gastrointestinal Hemorrhage
Hematemesis
Hemorrhage*
Humans
Jejunum
Kidney Failure, Chronic*
Laparotomy
Ligaments
Renal Dialysis