title: [Jejunal duplication in an adult presenting with hematochezia].
abstract: A 56-year-old man was admitted to our hospital with appetite loss, palpitations, orthostatic syncope, and hematochezia. Contrast-enhanced abdominal computed tomography (CT) revealed a proximal jejunal diverticulum with contrast extravasation. We immediately performed transoral double balloon enteroscopy (DBE) to treat the bleed in the jejunum, and this revealed a small ulcer with an exposed vessel at the opening of the jejunal diverticulum. Hemostasis was achieved endoscopically with argon plasma coagulation (APC) and hemoclips. During subsequent surgery, the diverticulum was found on the mesenteric side of the jejunum. We performed laparoscopy-assisted partial resection of the jejunum, and pathological examination showed that the diverticulum shared a common proper muscle layer with the jejunum and was covered by jejunal mucosa with no ectopic mucosa. Therefore, we diagnosed jejunal duplication. After hospital discharge, the patient had no recurrence of hematochezia or anemia. We report a rare case of jejunal duplication presenting with hematochezia, which was diagnosed as jejunal diverticular bleeding by CT and DBE before surgery. Pathological analysis confirmed jejunal duplication after surgery. We suggest that intestinal diverticular bleeding, as well as duplication of the gastrointestinal tract, should be considered as part of the differential diagnosis of obscure gastrointestinal bleeding.
authors.affiliation: Department of Gastroenterology, Izumi General Medical Center.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Inoue
authors.forename: Toshio
authors.initials: T
authors.lastname: Sakiyama
authors.forename: Kanae
authors.initials: K
authors.lastname: Setoyama
authors.forename: Yuji
authors.initials: Y
authors.lastname: Iwashita
authors.forename: Seiya
authors.initials: S
authors.lastname: Saito
authors.forename: Norihisa
authors.initials: N
authors.lastname: Hanada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Komohara
authors.forename: Fumisato
authors.initials: F
authors.lastname: Sasaki
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Numata
authors.forename: Akio
authors.initials: A
authors.lastname: Ido
mesh_terms: D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007583:Jejunum / Q000002:abnormalities* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography