title: Massive bleeding from a ruptured artery in jejunal diverticulosis without pre-existing mucosal inflammation or ulceration.
abstract: A case of massive bleeding from a ruptured artery in jejunal diverticulosis without pre-existing mucosal inflammation or ulceration is presented. A 75-year-old bed-ridden man had massive gastrointestinal bleeding and deteriorated to a state of shock rapidly. Panendoscopy, selective abdominal angiography, and radionuclide scanning were performed, but none of these studies revealed the exact bleeding point. Emergent operation revealed a segment of jejunal diverticulosis with bleeding, and it was resected. Pathologic examination revealed tortuous veins in the submucosa of diverticula and a ruptured artery with evidence of active bleeding in a large diverticulum. No pre-existing mucosal inflammation or ulceration was seen. The bleeding cause is thought to be acquired false diverticular wall tearing of a submucosal artery by bowel distension or unknown moving content.
authors.affiliation: Department of Surgery, Mackay Memorial Hospital, #92, Sec. 2, Zhong-Shan N. Rd, Taipei, Taiwan. crs.liuck@msa.hinet.net.
authors.forename: Chien-Kuo
authors.initials: CK
authors.lastname: Liu
authors.affiliation: Department of Pathology, Hsin-chu Mackay Memorial Hospital, Hsin-chu, Taiwan.
authors.forename: Kuo-Ming
authors.initials: KM
authors.lastname: Chang
keywords: Jejunal diverticulosis; Massive bleeding; Mucosal inflammation; Mucosal ulceration