Massive gastrointestinal (GI) bleeding can occur with multiple jejunal diverticulosis. However, significant bleeding in the setting of few diverticulae is very unusual and rare. We report a case of massive gastrointestinal bleeding from an arteriovenous malformation (AVM) within a jejunal diverticulum to underscore the significance of such coexisting pathologies. Mesenteric angiogram was chosen to help identify the source of bleeding and to offer an intervention. Despite endovascular coiling, emergent intestinal resection of the bleeding jejunal segment was warranted to ensure definitive treatment. However several reports have shown jejunal diverticulosis as a rare cause of massive GI bleeding. The coexistence of jejunal diverticulum and AVM is rare and massive bleeding from an acquired Dieulafoy-like AVM within a diverticulum has never previously been described. Awareness of Dieulafoy-like AVM within jejunoileal diverticulosis is useful in preventing delay in treatment.
Jejunal diverticulosis is a rare clinical entity that is often asymptomatic [
A 91-year-old previously healthy woman presented with hematochezia and hypotension. Esophagogastroduodenoscopy with push enteroscopy and colonoscopy revealed fresh bleeding from an inaccessible segment of small bowel between the mid jejunum and terminal ileum. Selective splanchnic arterial angiography showed extravasation of contrast from the mid-jejunal branch of the superior mesenteric artery (Figures
First described by Soemmering and Baillie in 1794, jejunal diverticulosis is a rare clinical entity with an overall frequency of about 0.7% [
Jejunal diverticulosis is characterized by herniation of mucosa and submucosa through the muscular layer of the bowel wall on the mesenteric border of the jejunum. Though the etiology is still unclear, most agree that increased intraluminal pressure leads to its development [
Jejunoileal diverticulosis is usually clinically silent until it presents with complications, which include chronic abdominal pain, malabsorption from bacterial overgrowth, diverticulitis, hemorrhage, small bowel obstruction, and perforation [
Vascular lesions such as AVMs and venous ectasias are the most common causes of small bowel hemorrhage [
Evaluation of bleeding jejunal diverticula can be identified by radioisotope-tagged red cells, angiography, or double-balloon enteroscopy [
Treatment options depending on their hemodynamic status include angiography with embolization, double balloon enteroscopy [
In conclusion, several groups have reported that GI bleeding from jejunal diverticulosis is rare [