A Case of Massive Bleeding in Jejunal Tuberculosis Treated by Transcatheter Embolization

Yang, Moon Hee; Jeong, Seok; Lee, Jin Woo; Lee, Don Haeng; Kim, Pum Soo; Kim, Hyung Gil; Park, Sang Woo; Kim, Hoon Soo; Lee, Chang Kun; Kim, Wha Sook; Kwon, Kye Sook; Cho, Hyeon Geun; Shin, Yong Woon; Kim, Young Soo

Abstract

Common complications of the intestinal tuberculosis are perforation, obstruction, fistulas, and malabsorption. Massive gastrointestinal bleeding is an extremely rare complication of intestinal tuberculosis. Moreover, this may be the first report in the world on transcatheter arterial embolization against the massive bleeding from intestinal tuberculosis patient. We experienced a case of lower gastrointestinal bleeding due to extensive intestinal tuberculosis as massive as vital sign was unstable. Colonoscopy and esophagogastroduodenoscopy did not reveal bleeding focus. Active jejunal bleeding was suspected by technetium99m labelled RBC scintigraphy. Emergency superior mesenteric artery angiography showed active bleeding focus from jejunal branch of artery and transcatheter arterial embolization was tried with microcoil. After embolization, he had no more hematochezia and vital sign became stabilized. On third hospital day, upper endoscopy was done using pediatric colonoscopy and there were multiple circular ulcers on the proximal jejunum but no evidence of mesenteric ischemia. Small bowel tuberculosis should be suspected as a cause of lower gastrointestinal bleeding in case of negative colonoscopy and upper endoscopy. We suggest that the transcatheter embolization could be taken into consideration as a first-line method of treatment for massive bleeding from intestinal tuberculosis before surgical resection.