Diagnosis and management of jejunoileal diverticular haemorrhage: An update on the experience in a single centre

PLoS One. 2020 Jun 23;15(6):e0234417. doi: 10.1371/journal.pone.0234417. eCollection 2020.

Abstract

Introduction: Jejunoileal diverticular haemorrhage is a rare disease that is difficult to diagnose and treat. Despite advances in endoscopic technology, recommendations on diagnosis and management for jejunoileal diverticular haemorrhage have remained unchanged and these new options have not been compared against traditional surgical management.

Materials and methods: We retrospectively reviewed the diagnosis, management, and outcome for jejunoileal diverticular haemorrhage cases at our institution over the past 20 years. Data were organized and analysed by chi-square test, student t-test and Kaplan-Meier survival analysis.

Results: The most utilised diagnostic procedure was computed tomography, followed by enteroscopy, angiography, small bowel flow-through and surgery. Primary treatments included, in a decreasing order, medical therapy, surgery, endoscopy and radiology. Surgical treatment was not associated with rebleeding, but it did result in longer hospital stays and larger blood transfusions than non-surgical treatments. The bleeding-related mortality rate was very low. Notably, there was also little change in the diagnosis and treatment between decades.

Conclusion: We presented our experience with the diagnosis and management of jejunoileal diverticular haemorrhage, as well as long-term follow-up after treatments that have not been reported previously. Surgical treatment continues to dominate management for jejunoileal diverticular haemorrhage, but we support increasing the role of endoscopy for select patient groups.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiography
  • Diagnostic Techniques, Digestive System / trends
  • Diverticulum / diagnosis*
  • Diverticulum / surgery
  • Diverticulum / therapy*
  • Endoscopy, Gastrointestinal
  • Female
  • Gastrointestinal Hemorrhage / diagnosis*
  • Gastrointestinal Hemorrhage / surgery
  • Gastrointestinal Hemorrhage / therapy*
  • Humans
  • Ileal Diseases / diagnosis*
  • Ileal Diseases / surgery
  • Ileal Diseases / therapy*
  • Jejunal Diseases / diagnosis*
  • Jejunal Diseases / surgery
  • Jejunal Diseases / therapy*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Taiwan
  • Tomography, X-Ray Computed

Grants and funding

The authors received funding from Changhua Christian Hospital (http://www2.cch.org.tw/cch_english/) for this work: numbers 106-CCHIRP-030 and 108-CCHIRP-018 for Dr Hsu-Heng Yen, and number 105-CCH-IRP-071 for Dr Fu-Yuan Siao. The funder played NO role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.