Enteroscopic Diagnosis and Management of Small Bowel Diverticular Hemorrhage: A Multicenter Report from the Taiwan Association for the Study of Small Intestinal Diseases

Abstract

Small bowel diverticulum is a rare cause of gastrointestinal bleeding. The diagnosis and treatment of small bowel diverticular hemorrhage is clinically challenging before the development of deep enteroscopy. In this multicenter study from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID), 608 patients underwent deep enteroscopy for obscure gastrointestinal bleeding during January 2004 and April 2010 from eight medical centers in Taiwan. Small bowel diverticular hemorrhage account for 7.89% of obscure gastrointestinal bleeding in this study. Most of the patients received endoscopic therapy with an initial hemostasis rate of 85.71% and rebleeding rate of 20%. In this large case series investigating the enteroscopic management of small intestinal diverticular hemorrhage, we found that, as to patients with peptic ulcer hemorrhage, most of these patients can be successfully managed by endoscopic therapy before surgery in the era of deep enteroscopy.

Non-Meckel's Small Bowel Diverticular Bleeding: Two Case Reports and a Review of the Literature

“…With widespread adoption of video capsule and deep enteroscopy, more cases have been noted since 1992. In a retrospective study from 8 Taiwanese centers spanning 2004–2010, non-Meckel’s small bowel diverticular bleeding was seen in 8% of patients who underwent double-balloon enteroscopy to evaluate obscure bleeding 14. Initial hemostasis was achieved with endoscopic therapy in 86% of patients, but, as was seen in our second patient, re-bleeding was common (recurring in 20% of patients).…”

An unusual case of giant ileal diverticulum–A case report

“…Diverticular bleeding of the small bowel is rare and occurs primarily in adults aged more than 60 years of age [8] . In a multicenter retrospective study from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID), non- Meckel’s small bowel diverticular bleeding was seen in 8% of patients with obscure gastrointestinal bleeding who underwent double balloon enteroscopy [9] .…”

“…In the Taiwanese study, initial hemostasis for small bowel diverticular bleeding was achieved with endoscopic therapy in 86% of patients but re-bleeding was common [9] . In our case, hemostasis was achieved and surgery was avoided which would have been extremely high risk in view of the immunocompromised state.…”

Jejunal Diverticulum Presenting As a Midgut Volvulus

“…The diverticula usually form the lead point of the intussusception. The occurrence of hemorrhage from diverticula can be difficult to diagnose but recent modalities of treatment include endoscopic therapy, with an initial hemostasis of 85.71% and a re-bleed rate of 20% [6] .…”