Enteroscopic Diagnosis and Management of Small Bowel Diverticular Hemorrhage: A Multicenter Report from the Taiwan Association for the Study of Small Intestinal Diseases
During a ten year interval, four patients with extensive rectal bleeding from jejunal diverticula were treated in a city of 750,000 people. Patient ages ranged from 54 to 66 years. All of the patients presented with bright red rectal bleeding. Bleeding scans demonstrated a source of blood loss high in the small intestine in two patients who had jejunal diverticula at exploratory laparotomy. In another patient, the results of preoperative evaluation did not reveal the site of hemorrhage. Jejunal diverticula were found at exploratory laparotomy. These three patients underwent jejunal resection and have since remained free of gastrointestinal bleeding. In the fourth patient, mesenteric arteriography revealed extravasation from a jejunal diverticulum. After angiography, the patient experienced no further hemorrhage, and surgical treatment was not performed. This patient remained asymptomatic and died of myocardial infarction five years later. The successful nonoperative management of this patient belies the high reported incidence of recurrent hemorrhage associated with jejunal diverticula. Thus, patients with rectal bleeding who are found to have jejunal diverticula should undergo removal of the involved jejunum, even if preoperative evaluation results implicate another source. The results of this study suggest that jejunal diverticula are a more frequent cause of extensive rectal bleeding than heretofore appreciated, particularly in the elderly.