Endoscopic Management of Jejunal Diverticular Bleeding: A Case Report and Systematic Review of the Literature.

Bleeding from a jejunal diverticulum is a rare and potentially severe condition, challenging both to diagnose and to treat. We report the case of a 56-year-old woman presenting with massive melena, who initially underwent esophagogastroduodenoscopy (EGD) and abdominal angio-CT, both unable to identify the bleeding source. After negative urgent ileocolonoscopy, second-look EGD showed fresh blood in the distal duodenum with no potentially bleeding lesions. This observation prompted us to perform a push enteroscopy that revealed an ulcer with oozing bleeding from a vessel located on the neck of a jejunal diverticulum. Hemostasis was successfully achieved by the placement of 4 through-the-scope clips. Currently, device-assisted enteroscopy (DAE) is the standard technique for the treatment of most causes of small bowel bleeding. However, DAE is performed only by dedicated endoscopists, is not available on a large scale, and is time-consuming. The present case report suggests the possible role of push enteroscopy as both a diagnostic and therapeutic procedure in the presence of signs suggesting a proximal origin of small bowel bleeding. This technique may indeed avoid unnecessary delay in small bowel bleeding management.