Massive Lower Gastro-Intestinal Bleeding Due to Small Bowel Diverticula. A Report of Two Cases

Abstract

Gastro-intestinal bleeding from the small bowel is a rare entity. It is difficult to determine the source of bleeding because of the unavailability of routine small bowel endoscopy. The most common reasons for bleeding from the small bowel are tumours, arteriovenous malformations and inflammatory bowel diseases. Diverticula of the small bowel are very uncommon. We present two cases of gastro-intestinal bleeding due to small bowel diverticula. Both of them were diagnosed on laparotomy. One had a short segment of small bowel, with six diverticula, which was resected. The second case had a long segment of small bowel with multiple diverticula. This patient was treated by isolating and excising the bleeding diverticulum. Haemodynamically unstable lower gastro-intestinal bleeding mandates exploratory laparotomy. Mesenteric angiography and Tc 99 labelled erythrocyte scintigraphy can detect the bleeding site. Intra-oper-ative endoscopy can be performed safely via an enterotomy and can localize the bleeding site.

Key Words:

• Lower gastro-intestinal bleeding
• small bowel diverticula
• intra-operative endoscopy

Additional information

Notes on contributors

M. Akyüz

M. Akyüz, M.D. Istanbul University, Faculty of Medicine Department of General Surgery Millet caddesi, Capa 34390 Istanbul, Turkey Tel.: [phone] Fax: [phone] E-mail: [email protected]