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Revista Española de Enfermedades Digestivas

versión impresa ISSN 1130-0108

Rev. esp. enferm. dig. vol.97 no.1 Madrid ene. 2005



Severe gastrointestinal bleeding associated to massive jejunal diverticulosis and Sintrom® treatment

M. Socas, J. Rodríguez, M. Flores, Z. Valera, M. A. Herrera, J. M. Álamo, I. Durán and F. Ibáñez

Departamento de Cirugía General. Hospitales Universitarios Virgen del Rocío. Hospital General. Sevilla, Spain


We report the case of a sixty-year-old female patient who was admitted to hospital with severe gastrointestinal bleeding originated in the lower part of the gastrointestinal tract associated with unconsiousness. She had a history of chronic atrial fibrillation under treatment with Sintrom®. On admission, her general state was poor, with pale skin and mucous membranes, and low blood pressure. A blood test revealed that hemoglobin was 5 g/l. A coagulation test revealed an International Normalized Ratio of 3. We proceeded to correct coagulation and to administer a blood transfusion; after hemodinamic stabilization, we performed an arteriography (Fig. 1), which showed bleeding points associated with the upper mesenteric artery. An urgently indicated operation was carried out, which revealed a massive diverticulosis of the jejunum-ileum without any other findings (Fig. 2). A resection of the involved part of the small bowel was performed with an end-to-end anastomosis. The patient died 24 hours afterwards in the critical care unit from multiple organ failure.



Diverticulosis of the jejunum-ileum is rare when compared to diverticular disease of the colon (1); it is a presumably acquired disease that is more frequent in elderly patients. Usually latent, these diverticulae are generally recognized during an urgent laparotomy for their complications. Small-bowel diverticulosis may be complicated by malabsorption due to bacterial overgrowth in excluded loops of small intestine, massive hemorrhage, diverticulitis, perforation, intestinal obstruction due to mechanical ileus caused by adhesions following diverticulitis, or small bowel obstruction secondary to an enterolith formed within a small bowel diverticulum (2,3). Treatment is considered only in case of a complication, and usually comprises a segmental resection of the small intestine portion involved (4).


1. Kaska M, Pospisil I, Andrejsova H, Rejtar P. Diverticulosis of the small intestine, case report. Rozhl Chir 2000; 79 (5): 221-3.

2. Englund R, Jensen M. Acquired diverticulosis of the small intestine: case reports and literature review. Aust N Z J Surg 1986; 56 (1): 51-4.

3. Mazuch J, Bruncak P, Kunik Z, Machan L, Misanik L. Diverticulosis of the small intestine. Bratisl Lek Listy 1995; 96 (8): 442-6.

4. Zemlianoi AG, Danenkov AS, Chkhaidze ZB. Treatment of total diverticulosis of the small intestine. Vestn Khir Im I I Grek 1990; 145 (10): 31-5.

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