Jejunal diverticula are rare anatomical abnormalities of the small intestine, often asymptomatic but capable of presenting with life-threatening gastrointestinal (GI) hemorrhage. Diagnosing obscure GI bleeding (OGIB) becomes particularly challenging when conventional modalities, such as upper and lower endoscopy or CT angiography, fail to identify the source. This is especially true in elderly patients with chronic nonsteroidal anti-inflammatory drug (NSAID) use, a known risk factor for small bowel pathology. We report the case of a 66-year-old woman with chronic NSAID use who presented with melena and hemorrhagic shock. Initial investigations, including upper endoscopy, colonoscopy, and CT angiography, were non-diagnostic. Despite aggressive resuscitation, the patient remained unstable with ongoing bleeding. Exploratory laparotomy with intraoperative enteroscopy revealed an actively bleeding jejunal diverticulum. A segmental resection of the affected small bowel was performed, followed by primary anastomosis. Postoperatively, the patient's hemoglobin stabilized, and she was discharged after an uneventful recovery. This case underscores the importance of considering jejunal diverticulosis in the differential diagnosis of OGIB, particularly in high-risk patients. Surgical intervention with intraoperative enteroscopy can serve as both a diagnostic and life-saving therapeutic tool when less invasive approaches fail.
Batra et al. (Sun,) studied this question.