Clin Endosc.  2017 Sep;50(5):495-499. 10.5946/ce.2016.154.

Congenital Jejunal Diverticular Bleeding in a Young Adult

• Lee JY
• Jang JY
• Kim MJ
• Lee TI
• Kim JW
• Chang YW

• KMID: 2394751
• DOI: http://doi.org/10.5946/ce.2016.154

Abstract

Diverticular bleeding of the small bowel is rare and occurs primarily in adults aged more than 60 years. In younger adults, Meckel's diverticulum, a true diverticulum that congenitally occurs in the distal ileum, is the most common cause of diverticular bleeding of the small bowel. Unlike Meckel's diverticula, other kinds of small bowel diverticula are not congenital and their incidence is related to age. Furthermore, congenital true diverticular bleeding of the jejunum in adults is very rare. We report the case of a 24-year-old man with subepithelial tumor-like lesion accompanied with obscure overt gastrointestinal bleeding. This lesion was initially suspected to be a subepithelial tumor based on radiologic tests and capsule endoscopy. He was finally diagnosed with a congenital true diverticulum in the jejunum with the appearance of a Meckel's diverticulum after surgical resection.

Keyword

Gastrointestinal hemorrhage; Meckel diverticulum; Neoplasms, glandular and epithelial; Jejunum

MeSH Terms

Adult
Capsule Endoscopy
Diverticulum
Gastrointestinal Hemorrhage
Hemorrhage*
Humans
Ileum
Incidence
Jejunum
Meckel Diverticulum
Neoplasms, Glandular and Epithelial
Young Adult*

Figure

• 

  Fig. 1. Abdominal computed tomography. (A) The axial view shows a pouch or mass-like lesion of the small bowel in the right middle abdomen with thickening of the bowel wall. (B) In the coronal view, the yellow arrow indicates circumferential wall thickening of the jejunal loop in the right middle abdomen and dilatation of the proximal area.

• 

  Fig. 2. (A, B) Capsule endoscopy showing a mass-like lesion at the jejunum without mucosal changes suggesting ulcer or erosion. The consistency of the lesion was uncertain. Finally, after surgical resection, this lesion was confirmed to be a mucosal hypertrophy with diverticular orifice.

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  Fig. 3. Macroscopic examination. (A) The orifice of the blind pouch in the jejunum (black arrow) is surrounded by irregular elevated mucosa. (B) A cut section shows that the blind pouch had a muscular layer (the black arrow indicates the orifice and the diverticula pouch were demarcated by white arrows).

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  Fig. 4. Microscopic examination. (A) Microscopically, the blind pouch is revealed to be a true diverticulum with a muscular layer (H&E stain, ×12.5). (B) Diverticulum is lined by gastric oxyntic mucosa (H&E stain, ×400).

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