Hospital: Hospital Universitario La Paz.
Aut@r o Autores: Y. Navarro Monforte, M. Nogueras Carrasco, S. Ossaba Vélez, C. Vilches Catalán, M. Caicoya Boto.
An 87-year-old woman presented to the Emergency Department for diffuse abdominal pain with rectal bleeding episode and subsequent syncope. Hemodynamically unstable. Rectal examination shows hematochezia. Angio-CT is requested with suspicion of low digestive hemorrhage versus ischemic colitis. Findings: Angio-CT detected multiple small bowel diverticula and revealed significant contrast extravasation within one of them in the middle jejunum, which also showed signs of inflammation and adjacent gas bubbles and small abscess. Diagnosis: Jejunal diverticulitis with contained perforation and signs of active bleeding. Given the hemodynamic instability of the patient, urgent surgery was decided.
Jejunoileal diverticulosis is a rare pathology, with a reported incidence of 0.06–2.3% in contrast studies, rising to 0.3–4.5% in autopsy studies1. They are often asymptomatic and diagnosis is usually made incidentally or after complications, which occur in 1020% of the cases and includes diverticulitis, perforation, obstruction and hemorrhage. Therefore, these complications should be included on our differential diagnosis for any patient with an acute abdomen of unknown origin. Among them, diverticulitis is the most frequent complication. Perforation is usually contained and only causes localized peritonitis, since diverticula are often walled off by the surrounding mesentery. Nevertheless, mortality rates for perforations range from 21% to 45%, as a result of diagnosis delay. Severe gastrointestinal bleeding (GB) secondary to jejunal diverticulosis is very rare, seen in 3.4%-8.1% of the cases, with approximately 50 documented cases in the literature2. Delay in establishing a diagnosis is also common, so that gastrointestinal bleeding secondary to jejunal diverticula is also associated with significant morbidity and mortality. The role of the radiologist in cases of GB is very important. Angio-CT is an effective tool to identify the precise focus of bleeding, thus allowing an early treatment.
Small bowel diverticulosis and especially jejunal diverticula is a very rare entity, but itcan be a cause of acute abdomen, including digestive hemorrhage. These cases present a high morbidity and mortality rate, partly due to a delay in management, which is why our role as radiologists for an early diagnosis is required.
- Tenreiro N. et al. Jejunoileal diverticulosis, a rare cause of ileal perforation - Case report. Annals of Medicine and Surgery. 2016, 6:56-59. 2. Abegunde AT, Christman E, Hassell LA, Kastens D. Rare Jejunal Diverticular Bleeding. ACG Case Rep J. 2016,