Jejunal Diverticular Bleed: A Rare Cause of Gastrointestinal Bleeding Diagnosed on Deep Enteroscopy

CASE REPORT A 69-year-old man with a history of total proctocolectomy and end ileostomy was admitted for evaluation of multiple episodes of painless bloody ileostomy output. A complete blood count showed hemoglobin of 8 g/dL. Esophagogastroduodenoscopy, ileoscopy, and computed tomography (CT) angiography failed to reveal the site or etiology of bleeding. A repeat deep ileoscopy, CT angiography, and 3 mesenteric angiograms, including 1 with a provocative maneuver, could not identify any active bleeding (Figure 1). Video capsule endoscopy demonstrated an active bleeding site in the mid-jejunum (Figure 2). An immediate push enteroscopy revealed several small-to-large diverticula in the proximal-to-mid-jejunum with evidence of recent bleeding (Figure 3). He underwent exploratory laparotomy with segmental small bowel resection (Figure 4) followed by end-to-end anastomosis. During this hospital course, the patient was transfused 26 units of packed red blood cells, 8 fresh frozen plasma units, and 4 platelets.Figure 1.: Mesenteric angiogram without evidence of active bleeding.Figure 2.: Video capsule endoscopy demostrating active bleeding in the region of mid-jejunum.Figure 3.: Push enteroscopy revealing several small-to-large diverticula in the proximal-to-mid-jejunum.Figure 4.: Resected small bowel showing multiple small and large diverticula.Small bowel diverticulosis is rare, with an estimated prevalence of 0.3%–1.3% in the general population.1 While most small bowel diverticula occur without complication, they can cause life-threatening complications, including bleeding, obstruction, and perforation.2,3 Jejunal diverticulosis can be challenging to diagnose and should be considered in the differential diagnosis of patients with recurrent lower gastrointestinal bleeding. DISCLOSURES Author contributions: H. Gopakumar: conceptualization of this case report, provided the images, revised the manuscript, and is the article guarantor. L. Chidichimo and A. Dayal: wrote the manuscript and reviewed the literature. I. Balouch: reviewed final version of the manuscript and provided expert input. Financial disclosure: None to report. Informed consent was obtained for this case report.