{"id":6675,"date":"2023-06-07T12:04:08","date_gmt":"2023-06-07T12:04:08","guid":{"rendered":"https:\/\/www.kauveryhospital.com\/ima-journal\/?p=6675"},"modified":"2025-04-09T11:34:56","modified_gmt":"2025-04-09T11:34:56","slug":"case-of-jejunal-diverticular-bleed","status":"publish","type":"post","link":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/","title":{"rendered":"Case of Jejunal Diverticular Bleed"},"content":{"rendered":"<p class=\"caps\">[vc_row][vc_column][vc_column_text]<\/p>\n<p style=\"text-align: justify;\">63 years old female known case of diabetes mellitus and systemic hypertension presented with complaints of abdominal pain, loose stools for 5 days. On examination BP \u2013 140\/80\/PR-86 bpm\/SPO2 \u2013 98 percent. Per abdomen examination showed tenderness in umbilical region, no guarding and rigidity. Other system examination were normal. Blood investigation showed elevated WBC counts [14500], CRP [53], RFT and LFT were normal. She was started on intravenous antibiotics and other supportive measures. In the view of persistent abdominal pain CT abdomen with oral contrast was done which showed multiple diverticulosis along the stomach, dueodenum, jejunum, ascending and descending colon. On third day of admission she developed per rectal bleeding which was massive\/painless and bright red in colour. Sigmoidoscopy was done immediately which showed clots along the sigmoid colon and source of bleeding could not be identified. Her hemoglobin and hematocrit were progressively dropping hence upper and lower GI scopy was done which does not reveal the site of bleeding. Her HB was significantly dropping and also she continued to have per rectal bleeding. She was transfused with PRBC and then planned for CT abdominal angiography which showed a bleeding source from jejunal branches of SMA artery into the jejunum. Immediately angioembolization of the bleeding vessel was done and post procedure her HB and HCT was stable. Melena was also settling gradually.<\/p>\n<h2><strong>DISCUSSION<\/strong><\/h2>\n<p style=\"text-align: justify;\"><strong>What is Diverticulitis?<\/strong><br \/>\nDiverticulosis are the outpouchings of the mucosa and submucosa into muscularis propria. Diverticulitis results from microperforation of a diverticulum and intramural inflammation. Most common site for diverticulitis is the sigmoid colon.<\/p>\n<p style=\"text-align: justify;\"><strong>Does Diverticular Bleed Requires Active Intervention?<\/strong><br \/>\nDiverticular bleed is a complication of diverticulitis and 70 percent of the bleed will resolve on its own and only 30 percent with persistent bleed requires intervention like angioembolization of the bleeding vessel or cauterization.<\/p>\n<p><strong>How a diverticulitis present?<\/strong><br \/>\nMost commonly diverticulitis presents with left lower abdominal pain and it varies with the site of diverticulitis \/ fever \/ altered bowel habits \/ nausea \/ vomiting. Diverticulitis can present with complications like per rectal bleeding [bleeding will be a painless intermittent and large volume lower GI bleed] perforation and features of peritonitis and features of colonic obstruction.<\/p>\n<p style=\"text-align: justify;\"><strong>How to approach and manage a case of diverticular bleed?<\/strong><br \/>\nDiverticular bleed is the most common cause for lower GI bleed. Algorithm for managing a diverticular bleed includes the initial resuscitation which is the foremost part and diagnostic evaluation of the source of bleed has to be done .colonoscopy is the initial diagnostic procedure. Investigations like upper GI scopy , CT angiography, radionucleotide with technetium 99 can be done.<\/p>\n<p style=\"text-align: justify;\">Endoscopic band ligation of the artery can be done if active bleeding is identified with upper or lower GI scopy .other intervention like angioembolization of the bleeding vessel [it also carries a risk of bowel ischemia] .If the bleeding is persistent with less invasive methods and if patient presents with recurrent bleed resection and anastomosis is considered.<\/p>\n<p>&nbsp;<\/p>\n<p><strong><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-6835\" src=\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2023\/06\/dr.rvnayaki-262x300.jpg\" alt=\"\" width=\"155\" height=\"178\" srcset=\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2023\/06\/dr.rvnayaki-262x300.jpg 262w, https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2023\/06\/dr.rvnayaki.jpg 300w\" sizes=\"auto, (max-width: 155px) 100vw, 155px\" \/>Dr. Rajavanjinayaki<\/strong><br \/>\n<em>DNB 1st Year Post Graduate (General Medicine)<\/em><br \/>\nKauvery Hospital Chennai[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text] 63 years old female known case of diabetes mellitus and systemic hypertension presented with complaints of abdominal pain, loose stools for 5 days. On examination BP \u2013 140\/80\/PR-86 bpm\/SPO2<\/p>\n","protected":false},"author":2,"featured_media":6676,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[54],"tags":[],"class_list":["post-6675","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ima-journal-june-2023"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Case of Jejunal Diverticular Bleed<\/title>\n<meta name=\"description\" content=\"63 years old female known case of diabetes mellitus and systemic hypertension presented with complaints of abdominal pain, loose stools for 5 days.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Case of Jejunal Diverticular Bleed\" \/>\n<meta property=\"og:description\" content=\"63 years old female known case of diabetes mellitus and systemic hypertension presented with complaints of abdominal pain, loose stools for 5 days.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/\" \/>\n<meta property=\"og:site_name\" content=\"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health\" \/>\n<meta property=\"article:published_time\" content=\"2023-06-07T12:04:08+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-04-09T11:34:56+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2023\/06\/bg-2023-june-2.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1308\" \/>\n\t<meta property=\"og:image:height\" content=\"545\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"kh-ima-admin\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"kh-ima-admin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/\",\"url\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/\",\"name\":\"Case of Jejunal Diverticular Bleed\",\"isPartOf\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2023\/06\/bg-2023-june-2.jpg\",\"datePublished\":\"2023-06-07T12:04:08+00:00\",\"dateModified\":\"2025-04-09T11:34:56+00:00\",\"author\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/a008aa764057e74557d708f2381a5acb\"},\"description\":\"63 years old female known case of diabetes mellitus and systemic hypertension presented with complaints of abdominal pain, loose stools for 5 days.\",\"breadcrumb\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/#primaryimage\",\"url\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2023\/06\/bg-2023-june-2.jpg\",\"contentUrl\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2023\/06\/bg-2023-june-2.jpg\",\"width\":1308,\"height\":545},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Case of Jejunal Diverticular Bleed\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#website\",\"url\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/\",\"name\":\"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health\",\"description\":\"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/a008aa764057e74557d708f2381a5acb\",\"name\":\"kh-ima-admin\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/6b190d48867033f0c3c0aac5530295535596218654f543741508cab11520ab8f?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/6b190d48867033f0c3c0aac5530295535596218654f543741508cab11520ab8f?s=96&d=mm&r=g\",\"caption\":\"kh-ima-admin\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Case of Jejunal Diverticular Bleed","description":"63 years old female known case of diabetes mellitus and systemic hypertension presented with complaints of abdominal pain, loose stools for 5 days.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/","og_locale":"en_US","og_type":"article","og_title":"Case of Jejunal Diverticular Bleed","og_description":"63 years old female known case of diabetes mellitus and systemic hypertension presented with complaints of abdominal pain, loose stools for 5 days.","og_url":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/","og_site_name":"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health","article_published_time":"2023-06-07T12:04:08+00:00","article_modified_time":"2025-04-09T11:34:56+00:00","og_image":[{"width":1308,"height":545,"url":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2023\/06\/bg-2023-june-2.jpg","type":"image\/jpeg"}],"author":"kh-ima-admin","twitter_card":"summary_large_image","twitter_misc":{"Written by":"kh-ima-admin","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/","url":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/","name":"Case of Jejunal Diverticular Bleed","isPartOf":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/#primaryimage"},"image":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/#primaryimage"},"thumbnailUrl":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2023\/06\/bg-2023-june-2.jpg","datePublished":"2023-06-07T12:04:08+00:00","dateModified":"2025-04-09T11:34:56+00:00","author":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/a008aa764057e74557d708f2381a5acb"},"description":"63 years old female known case of diabetes mellitus and systemic hypertension presented with complaints of abdominal pain, loose stools for 5 days.","breadcrumb":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/#primaryimage","url":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2023\/06\/bg-2023-june-2.jpg","contentUrl":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2023\/06\/bg-2023-june-2.jpg","width":1308,"height":545},{"@type":"BreadcrumbList","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2023\/case-of-jejunal-diverticular-bleed\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.kauveryhospital.com\/ima-journal\/"},{"@type":"ListItem","position":2,"name":"Case of Jejunal Diverticular Bleed"}]},{"@type":"WebSite","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#website","url":"https:\/\/www.kauveryhospital.com\/ima-journal\/","name":"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health","description":"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.kauveryhospital.com\/ima-journal\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/a008aa764057e74557d708f2381a5acb","name":"kh-ima-admin","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/6b190d48867033f0c3c0aac5530295535596218654f543741508cab11520ab8f?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/6b190d48867033f0c3c0aac5530295535596218654f543741508cab11520ab8f?s=96&d=mm&r=g","caption":"kh-ima-admin"}}]}},"_links":{"self":[{"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/posts\/6675","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/comments?post=6675"}],"version-history":[{"count":6,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/posts\/6675\/revisions"}],"predecessor-version":[{"id":6836,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/posts\/6675\/revisions\/6836"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/media\/6676"}],"wp:attachment":[{"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/media?parent=6675"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/categories?post=6675"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/tags?post=6675"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}