An 81-year-old man was referred because of severe iron deficiency anemia and episodes of melena. Despite several hospitalizations for this problem, a definitive diagnosis had not been made. Upper endoscopy and colonoscopy were negative, and an enteroclysis study revealed only jejunal diverticula (A). Tagged-red-blood-cell scintigraphy was positive for a bleeding site in the proximal gut, but the finding was not considered by the consulting surgeon as a sufficient indication for operation. At enteroscopy, a blood clot adherent to a jejunal diverticulum was found (B). Laparotomy revealed intestinal loops full of blood from about 40 cm distal to the ligament of Treitz. By using the enteroscopy findings as a guide, a large diverticulum was identified in the jejunum as the probable source of bleeding (C). The intestinal segment containing the diverticulum was resected. The postoperative recovery was uneventful, and, subsequent to discharge, the patient has had no further episodes of bleeding. Full-size image (15K) Full-size image (29K) Full-size image (25K)
C. Morselli, M. Bortolotti, E. Brocchi, V. Tonini, M. Cervellera, M. Miglioli (2004). Bleeding Jejunal Diverticulum. GASTROINTESTINAL ENDOSCOPY, 59 (2), 262-262 [10.1016/S0016-5107(03)02550-1].
Bleeding Jejunal Diverticulum
BROCCHI, EMILIO;TONINI, VALERIA;CERVELLERA, MAURIZIO;
2004
Abstract
An 81-year-old man was referred because of severe iron deficiency anemia and episodes of melena. Despite several hospitalizations for this problem, a definitive diagnosis had not been made. Upper endoscopy and colonoscopy were negative, and an enteroclysis study revealed only jejunal diverticula (A). Tagged-red-blood-cell scintigraphy was positive for a bleeding site in the proximal gut, but the finding was not considered by the consulting surgeon as a sufficient indication for operation. At enteroscopy, a blood clot adherent to a jejunal diverticulum was found (B). Laparotomy revealed intestinal loops full of blood from about 40 cm distal to the ligament of Treitz. By using the enteroscopy findings as a guide, a large diverticulum was identified in the jejunum as the probable source of bleeding (C). The intestinal segment containing the diverticulum was resected. The postoperative recovery was uneventful, and, subsequent to discharge, the patient has had no further episodes of bleeding. Full-size image (15K) Full-size image (29K) Full-size image (25K)I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
