Available online 23 April 2022

AbstractBackground and study aims

Small intestine diverticula are the most common cause of gastrointestinal hemorrhage, but prompt diagnosis remains challenging. Thus, this study aimed to identify strategies for the diagnosis and treatment of diverticular hemorrhage.

Patients and methods

Patients who presented with gastrointestinal tract bleeding to Guangzhou First People's Hospital between 2008 and 2014 were retrospectively examined. Gastrorrhagia and colonic hemorrhage were excluded based on the gastroscopy and colonoscopy findings, and the bleeding sites were in the small intestine. Data regarding patient characteristics, methods of diagnosis, treatment, and prognosis were collected.

Results

Eighty-five patients met the study criteria, and 45 patients were diagnosed with diverticular hemorrhage using double balloon enteroscopy, capsule endoscopy, computed tomography (CT), or digital subtraction angiography (DSA). Among these patients, 10 presented with massive bleeding and hemodynamic instability. All 45 patients underwent surgery and recovered with no complications, and all patients were followed-up for over 3 years, with no cases of recurrent hemorrhage.

Conclusion

Diverticular hemorrhage is the most common cause of small intestine bleeding. Double balloon enteroscopy, capsule endoscopy, CT, and DSA are effective methods for diagnosing small intestine diverticular hemorrhage. Surgical resection of the involved region is necessary and may achieve complete cure.

Introduction

The causes of gastrointestinal hemorrhage are complex and include ulcers, biliary infections, tumors, varices, and vascular malformations [1]. The most common sites of bleeding are the stomach, duodenum, and colon, and bleeding at these sites can easily be diagnosed using gastroscopy or colonoscopy [2]. However, small intestine hemorrhage is difficult to diagnose because the length of the small intestine is approximately 5 m. Although a range of techniques can be used to identify the cause of small intestine hemorrhage, an effective and accurate technique is still lacking [3].

A diverticulum is an outpouching of a hollow or fluid-filled structure in the gastrointestinal tract. Most diverticula are congenital malformations, lacking the muscular or adventitial layer, and involving only the mucosa and submucosa [4], [5]. Some diverticula have an arterial supply, which is typically the source of diverticular bleed [6]. Therefore, diverticular hemorrhage is the main cause of small intestine bleeding and may present as massive or recurrent bleeding. Diagnosing diverticular hemorrhage is challenging, and most diverticula need to be surgically removed [7]. This study aims to discuss the available techniques for the diagnosis and treatment of small intestine diverticular hemorrhage.

Section snippetsPatients and methods

We retrospectively examined the data of patients admitted to Guangzhou First People's Hospital with intestinal hemorrhage between 2008 and 2014. All the patients were admitted to the department of general surgery. Data regarding the patients’ general characteristics, including age at presentation, sex, body mass index, and comorbidities, were reviewed.

Patients’ general characteristics

Eighty-five patients were admitted with intestinal bleeding during the study period. Gastrorrhagia and colonorrhagia were excluded in all patients via endoscopy, and it was established that the site of bleeding was in the small intestine. Of these patients, 45 were diagnosed with small intestine diverticular hemorrhage. The general characteristics of the patients are shown on Table 1.

Different methods used for diagnosis

Of the 45 patients, 10 who had diverticular hemorrhage with hemodynamic instability were treated with DSA. In

Discussion

Hemorrhage of the gastrointestinal tract usually originates from the stomach or colon, and it is easily diagnosed using gastroscopy or colonoscopy. However, small intestine hemorrhage can be caused by complex conditions and can be difficult to diagnose because of the length of the small intestine. Diseases causing intestinal hemorrhage include hemangioma, vascular malformation, intestinal stromal tumors, diverticula, and intestinal lymphoma [8], [9]. Diverticula are found in 2% to 8% of cases

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

The authors thank all the participants who participated in this study.

Funding

This work was sponsored by the grants from the Guangzhou Municipal Health Technology Project (No. 20211A010004 and 20201A010005).

Authors’ contributions

LYQ conceived of the study, and participated in its design and coordination, and helped to draft the manuscript. HYX participated in drafting the manuscript and statistical analysis. WMJ participated in the design of the study and statistical analysis. YHT participated in the design of study and drafted the manuscript. All authors read and approved the final manuscript.

Ethics approval and consent to participate

The study protocol was approved by the Ethics Committee of Guangzhou First People’s Hospital. Consent to participate was not applicable.

References (30)S. Kawamoto et al.CT detection of symptomatic and asymptomatic Meckel diverticulum

AJR Am J Roentgenol

(2015)

E.P. Redman et al.Laparoscopic diverticulectomy or laparoscopic-assisted resection of symptomatic Meckel diverticulum in children? A systematic review

Pediatr Surg Int

(2020)

A.L. Bastawrous et al.Incidence, associated risk factors, and impact of conversion to laparotomy in elective minimally invasive sigmoidectomy for diverticular disease

Surg Endosc

(2020)

S. Shinozaki et al.Long-term outcomes in patients with overt obscure gastrointestinal bleeding after negative double-balloon endoscopy

Dig Dis Sci

(2015)

B. Murphy et al.Small bowel gastrointestinal bleeding diagnosis and management-A narrative review

Front Surg

(2019)

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© 2022 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.