Ma HC, Xiao H, Qu H, Wang ZJ. Successful diagnosis and treatment of jejunal diverticular haemorrhage by full-thickness enterotomy: A case report. World J Clin Cases 2021; 9(19): 5232-5237 [PMID: 34307572 DOI: 10.12998/wjcc.v9.i19.5232]
Corresponding Author of This Article
Zhen-Jun Wang, MD, PhD, Chief Doctor, Professor, Surgeon, General Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing 100020, China. zhenjun123wang@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 6, 2021; 9(19): 5232-5237 Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5232
Successful diagnosis and treatment of jejunal diverticular haemorrhage by full-thickness enterotomy: A case report
Hua-Chong Ma, Hui Xiao, Hao Qu, Zhen-Jun Wang
Hua-Chong Ma, Hui Xiao, Hao Qu, Zhen-Jun Wang, Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
Author contributions: Wang ZJ designed the report; Ma HC and Xiao H collected the patient’s clinical data; Ma HC and Qu H analyzed the data and wrote the paper.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement:
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-Jun Wang, MD, PhD, Chief Doctor, Professor, Surgeon, General Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing 100020, China. zhenjun123wang@163.com
Received: January 18, 2021 Peer-review started: January 18, 2021 First decision: February 11, 2021 Revised: February 18, 2021 Accepted: May 15, 2021 Article in press: May 15, 2021 Published online: July 6, 2021
Abstract
BACKGROUND
Jejunal diverticula are the rarest of all small bowel diverticula and usually have no classic clinical symptoms. Jejunal diverticular haemorrhage (JDH) is a rare complication and can be difficult to identify and manage, hence it always resulting in a diagnostic delay and unsatisfactory clinical outcomes. Although with the advances in endoscopic technology, no consensus have been reached on the diagnosis and management of JDH, the conventional surgical intervention still remains the mainstream for the management of JDH. We report an unique case of a 63-year-old male who presented with massive haemorrhage from jejunal diverticula, which was successfully managed by initial resuscitation and definitive surgery.
CASE SUMMARY
A 63-year-old male was admitted as an emergency with 6 h history of haematemesis and melena. The haematemesis appeared to be bright red, with volume exceeding 100 mL. The amount of melena was estimated to be 200 mL. Initially, the patient received fluid resuscitation and three unit blood transfusion. Then, in order to localize the bleeding sites, colonoscopy, upper gastrointestinal endoscopy, and mesenteric angiography were utilized but failed to identify the source of haemorrhage. Informed consent form was obtained for further treatment, and he was treated with an exploratory laparotomy and the bleeding site was successfully located during the procedure. He was diagnosed with JDH. The postoperative period was uneventful, and he was discharged on day 18 after surgery. No rebleeding occurred at the 1-year follow-up.
CONCLUSION
In patients with gastrointestinal bleeding, if various techniques fail to identify the cause of haemorrhage in small bowel and haemodynamic instability is sustained with continuous resuscitation, we recommend surgical intervention should be the ultimate treatment of choice.
Core Tip: In patients with gastrointestinal bleeding, if all methods have failed to identify the cause of haemorrhage in small bowel and haemodynamic instability sustains with continuous resuscitation, we recommend surgical intervention as the ultimate treatment of choice for jejunal diverticular haemorrhage. Surgeons should strictly follow the diagnosis and treatment guidelines of acute gastrointestinal bleeding and have a better understanding of the strengths and weaknesses of various techniques, which would be extremely helpful for selecting the optimal clinical pathways and conducting multidisciplinary collaboration accurately and quickly.
