Uncommon Cause of Jejunal Bleeding

A 72-year-old male with a past history of arterial hypertension and diabetes presented with melaena and haematochezia. On examination, he presented tachycardia (120 ppm) and hypotension (80/40 mm Hg). His blood tests showed normocytic anaemia (haemoglobin 7.4 g/dL). After receiving 2 units of red blood cells and haemodynamic stabilization, the patient underwent upper endoscopy, which was unremarkable except for antral gastropathy and a colonoscopy with ileoscopy that showed blood and recent clots in all segments, with no potentially bleeding lesions. Angio-CT had no signs of active bleeding. The patient underwent capsule endoscopy (CE) 5 days after the initial bleeding episode. Active bleeding was detected in the midjejunum (Fig. 1), but no source was identified. Antegrade double-balloon enteroscopy was performed under deep sedation 2 days after CE. In the proximal jejunum, a large diverticulum with a visible vessel at its base was detected (Fig. 2). A TTS clip was inadvertently misplaced 2 mm from the vessel causing spurting bleeding on its release (Fig. 3). Attempt to put a new clip or adrenaline injection, as well as marking with a carbon tattoo, was impaired by the massive bleeding that prevented diverticulum identification after thorough washing and aspiration. The patient was immediately referred to surgery. Intraoperatively, a large jejunal diverticulum (JD) was detected (Fig. 4). A segmental enterectomy with side-to-side jejunal anastomosis was performed. The patient recovered completely and uneventfully.