PTH-070 Severe midgut bleeding from jejunal diverticula treated by double-balloon enteroscopy

IntroductionSmall bowel diverticula are a rare cause of gastrointestinal (GI) bleeding. Their pathogenesis is still unclear and can be found in up to 1–2% of the general population. Although these lesions are usually asymptomatic, mid-gut bleeding from diverticula in the jejunum or ileum could lead to a life-threatening situation, warranting emergency invasive therapy and often abdominal surgery.Aims and MethodsOur aim was to demonstrate the usefulness of the double-balloon enteroscopy (DBE) in the setting of an acute, severe small bowel diverticular bleed. A 79-year-old woman with hypertension and type II diabetes mellitus was referred to our institution with melaena and severe anaemia requiring urgent, repeat blood transfusions. Bidirectional conventional endoscopy did not reveal the cause of bleeding. Small bowel capsule endoscopy (SBCE) showed multiple diverticula within the jejunum and ileum. Emergency computed tomography (CT) mesenteric angiography demonstrated a faint ‘blush’ at one of the jejunal lesions.ResultsOnce the patient w as haemodynamically stable, emergency anterograde DBE was performed under general anaesthesia (GA) in our main operating theatres. The enteroscope was inserted into the jejunum, approximately 1.5 meters post-pylorus. The culprit cause of the bleeding was identified within a large (5 cm orifice) diverticulum, where a large, adherent, pulsating blood clot was seen. In the first instance, peri-lesion, quadrantic injection of a total of 20 mls of adrenaline solution (1 in 10,000 dilution) was performed. The clot was then cautiously removed with a long endoclip to reveal the actively bleeding vessel which was then promptly clipped. A total of 3 clips were placed for effective haemostasis and a submucosal tattoo was placed adjacent to the bleeding point for future reference. The patient remained stable after the procedure and did not require any further blood transfusion.ConclusionDBE facilitated endotherapy is a precise, safe and minimally invasive approach to the effective management of severe bleeding caused by small bowel diverticula.