eP252 - A Rare Cause of Obscure Gastrointestinal Bleeding: Jejunal Diverticulosis

Purpose/Background: Gastrointestinal bleeding (GIB) remains complex as it can veritably result from any lesion or defect along the gastrointestinal tract. GIB can further be categorized as (1) upper or lower and (2) occult or obscure. Obscure GIB (OGIB) is bleeding otherwise unknown to the patient that fails source localization efforts by routine endoscopic evaluation. Of OGIB classifications, an additional subdivision proposes to differentiate between those with obvious bleeding, i.e., ‘obscure overt,’ and those without, i.e., ‘obscure occult.’ In either situation, localization of the bleeding source is paramount—specifically, the small bowel is a critical investigative component—owing to approximately 5% of all GIB. Furthermore, specific attention should be given to the use of anticoagulants that can inherently incur injury to the gastrointestinal mucosa.Methods/Interventions: We report a case of obscure-overt GIB in a 60-year-old moderately obese Caucasian male with clinically evident gastrointestinal bleeding that presented after anticoagulation for the treatment of bilateral deep venous thromboses. He received 28 units of packed red blood cells in a matter of ten days for resultant severe anemia. He underwent many negative localization studies, including endoscopic evaluation, computed tomography angiography (CTA), mesenteric angiography, and radionuclide imaging. Up until the point of surgical intervention, he was provided with somatostatin and hormone-based therapies.Results/Outcomes: Ultimately, he was brought to the operating room for exploratory laparotomy. The resection of a segment of proximal jejunum found to have extensive diverticulosis identified via intraoperative enteroscopy resulted in prompt and complete cessation of bleeding. He went without active evidence of GIB for the remainder of his hospitalization.Conclusion/

Discussion: Routine management of gastrointestinal bleeding should include appropriate resuscitation, correction of coagulopathy, transfusion as needed, careful monitoring in a critical care setting, aggressive localization of the bleeding source, and therapeutic intervention for definitive hemorrhage control. In cases of obscure gastrointestinal bleeding, localization can be challenging. Select patients may warrant surgical intervention with intraoperative enteroscopy. Jejunal diverticulosis is a rare cause of obscure gastrointestinal bleeding that may only be identified during surgical exploration. The recommended treatment, as reported within this case, is complete resection of grossly involved or overt bleeding segments.