Double-balloon enteroscopic treatment for bleeding jejunal diverticulum - 23/08/11
Doi : 10.1016/j.gie.2008.01.039
| Commentary Small bowel diverticula are seen in up to 5% of small bowel series and autopsies and usually involve the jejunum, more so than the ileum. They may be narrow-mouthed pulsion (false) diverticula with a thin or absent muscle coat, or wide-mouthed (true) diverticula with the muscle layer intact. Jejunal diverticulosis usually is clinically silent, but may be associated with a variety of manifestations: signs and symptoms of malabsorption from bacterial overgrowth, including diarrhea, abdominal discomfort, bloating, and borborygmi; and complications of diverticulitis including perforation, obstruction and, as in the present case, bleeding. The diverticulum was seen to rim with contrast, which could occur if a bolus of intravenous (or intra-arterial) contrast were given, or as a result of oral contrast simply filling it. A pathognomonic angiographic sign of a bleeding diverticulum is extravasation of contrast into the diverticulum. In the colon, however, I have seen such extravasation attributed to diverticular hemorrhage when, in fact, a bleeding angioectasia was located in the diverticular dome. In this case, double-balloon enteroscopy identified another vascular abnormality, ie, a Dieulafoy lesion that accounted for the bleeding, which, absent the endoscopy, also might have been attributed to the diverticulum. In H.M.S. Pinafore, Gilbert put it this way: “Things are seldom what they seem, skim milk masquerades as cream.” Well, as this case teaches us, diverticular hemorrhage usually is diverticular hemorrhage, but not always. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 68 - N° 2
P. 371-372 - août 2008 Retour au numéro
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