arteriovenous malformation within jejunal diverticulum an unusual cause of massive gastrointestinal bleeding内动静脉畸形空肠憩室胃肠大出血的一个不寻常的原因.pdfVIP

Hindawi Publishing Corporation Gastroenterology Research and Practice Volume 2009, Article ID 384506, 4 pages doi:10.1155/2009/384506 Case Report ArterioVenous Malformation within Jejunal Diverticulum: An Unusual Cause of Massive Gastrointestinal Bleeding Jeffrey K. Lee, John M. Carethers, and Pradipta Ghosh Department of Medicine, Division of Gastroenterology, University of California, San Diego, CA 92103, USA Correspondence should be addressed to Pradipta Ghosh, prghosh@ Received 23 June 2009; Accepted 6 August 2009 Recommended by Gianfranco D. Alpini Massive gastrointestinal (GI) bleeding can occur with multiple jejunal diverticulosis. However, significant bleeding in the setting of few diverticulae is very unusual and rare. We report a case of massive gastrointestinal bleeding from an arteriovenous malformation (AVM) within a jejunal diverticulum to underscore the significance of such coexisting pathologies. Mesenteric angiogram was chosen to help identify the source of bleeding and to offer an intervention. Despite endovascular coiling, emergent intestinal resection of the bleeding jejunal segment was warranted to ensure definitive treatment. However several reports have shown jejunal diverticulosis as a rare cause of massive GI bleeding. The coexistence of jejunal diverticulum and AVM is rare and massive bleeding from an acquired Dieulafoy-like AVM within a diverticulum has never previously been described. Awareness of Dieulafoy-like AVM within jejunoileal diverticulosis is useful in preventing delay in treatment. Copyright © 2009 Jeffrey K. Lee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Introduction