Arteriovenous malformations within jejunal diverticulosis: case report and literature review

Abstract

Background Jejunal diverticula are the rarest of all small bowel diverticula. Most patients with jejunal diverticula are asymptomatic. Major complications include diverticulitis, gastrointestinal hemorrhage, intestinal obstruction and perforation. The hemorrhage has been attributed to diverticulitis with ulceration, diverticulosis associated with trauma and irritation disorder. However, only six cases reported the arteriovenous malformations within jejunal diverticulosis to be the cause of hemorrhage. Case presentation We present a case of arteriovenous malformations within jejunal diverticulosis in a 68-year-old male presented with lower gastrointestinal bleeding. After admission and stabilization, upper and lower endoscopies were performed without demonstrating the bleeding site. They only revealed clotted and red blood throughout the colon. Technetium-labeled red blood cell bleeding scan, endoscopic capsule, and selective angiography were performed to localize the site of bleeding without significant findings. As the clinical status of the patient deteriorated, exploratory laparotomy was performed urgently. Extensive jejunal saccular pouches were found 10 cm distal to duodenojejunal junction extending 1.6 m distally. Segmental resection was performed with side to side primary anastomosis. Microscopic examination of the specimen revealed many diverticula. He was followed up 2 years after that without complications. Conclusion We report yet the seventh case jejunal diverticulosis with the presence of angiodysplasia, in hope of expanding the knowledge of a rare occurrence and increasing the demand for further research about the etiology, clinical impact and treatment of such anomalies coexistence. This case also highlights the importance of considering the diagnosis of AVMs within jejunal diverticulosis in the presence of uncontrollable blood loss in the pre- or intra- operatively diagnosed jejunal diverticulosis and the urgent need for surgical intervention. In addition, the diagnostic tests should be performed close to the bleeding episode.

Digestive bleeding due to jejunal diverticula: diagnosis and management

“…The risk of requiring subsequent diverticular resection after failed initial endoscopic or supportive treatments was 5.26% and 11.54%, respectively. Urgent exploratory laparotomy is well-defined when other diagnostic techniques fail to localise the source of bleeding in jejunal diverticular haemorrhage 24 32…”

Hemorrhagic shock due to colonic arteriovenous malformation in late pregnancy: a case report

“…Hemodynamic instability was reportedly exacerbated by hemorrhage secondary to intestinal AVM [ 7 ]. However, there are no reports of intestinal AVM causing hemodynamic instability in pregnant women.…”

Perforated jejunal diverticula in a young woman: A case report

“…Similar to the treatment of CDD, conservative medical treatment of SBD may be considered just to control diarrhea or mild anaemia [ 11 ]. If uncomplicated inflammation occurs, we suggest a regime of intravenous broad-spectrum antibiotics that covers enteric bacteria and close observation for the development of complications [ [18] , [19] , [20] ]. However, if medical management fails and the inflammation progresses or if signs of beginning abdominal sepsis are present (with or without the presence of peritonitis), surgical resection should be performed.…”