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Competing Interests: The authors declare that they have no conflict of interest.

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., Competing Interests: No authors have competing interests.

This case report describes an unusual case of upper gastrointestinal (UGI) bleeding caused by a ruptured superior mesenteric artery (SMA) aneurysm in the duodenum in a patient with rheumatoid arthritis. The patient presented with UGI bleeding and hemorrhagic shock. Emergency UGI endoscopy could not identify the source of the bleeding because of excessive blood clots under the second portion of the duodenum. An SMA aneurysm with active contrast extravasation was diagnosed by computed tomography. The aneurysm, together with the fourth portion of the duodenum and the proximal portion of the jejunum, was surgically resected, and the SMA was skeletonized. On postoperative day 15, the patient was discharged from hospital under satisfactory conditions. Rheumatoid arthritis has been known to cause a wide spectrum of manifestations, and an SMA aneurysm is an unusual extra-articular manifestation. An SMA aneurysm rupture presenting as upper gastrointestinal bleeding is a rare complication with a high mortality rate. The clinician must be alert to this potential issue to achieve rapid diagnostic confirmation, and immediate surgical or radiological intervention.

Objective: The aim of this study was to evaluate the clinical features and management of jejunoileal diverticular hemorrhage at Changhua Christian Hospital over the past decade., Methods: A retrospective study on the clinical features, treatment and outcomes of the patients with jejunoileal diverticular hemorrhage diagnosed from January 2000 to December 2010 was conducted., Results: Twenty-eight patients (male to female ratio 15:13) were enrolled in the study with a mean age of 73.9 years. Symptoms consisted of bloody stool (46.4%), tarry stool (82.1%), coffee ground vomitus (7.1%) and shock (39.3%). The mean duration of hospital stay was 13.5 days and the mean blood transfusion volume was 13.5 units. Eight patients (28.6%) underwent surgical resection, 9 (32.1%) received endoscopic therapy and 11 (39.3%) were administered conservative therapy. Five patients (17.9%) had recurrent bleeding during the follow-up. Two patients (7.1%) died eventually., Conclusions: The management of jejunoileal diverticular hemorrhage has mainly been nonsurgical at our institution over the past decade. The decreased requirement of surgical intervention might be attributed to the improvement of diagnostic and treatment procedures during this period., (© 2012 The Authors. Journal of Digestive Diseases © 2012 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.)

Aim: To evaluate the clinical impact of multidetector computed tomography (MDCT) before double-balloon endoscopy (DBE) for patients with obscure gastrointestinal bleeding (OGIB)., Methods: A retrospective analysis of prospectively collected cases with DBE and MDCT for overt OGIB was conducted from April 2004 to April 2010 at Changhua Christian Hospital. We evaluated the clinical impact of MDCT on the subsequent DBE examinations and the diagnostic yields of both MDCT and DBE respectively., Results: From April 2004 to April 2010, a total of 75 patients underwent DBE for overt OGIB. Thirty one cases received MDCT followed by DBE for OGIB. The overall diagnostic yields of DBE and MDCT was 93.5% and 45.2%. The MDCT had a high diagnostic yield of tumor vs non-tumor etiology of OGIB (85.7% vs 33.3%, P = 0.014). Additionally, the choice of initial route of DBE was correct in those with a positive MDCT vs negative MDCT (100% vs 52.9%, P = 0.003)., Conclusion: This study suggests MDCT as a triage tool may identify patients who will benefit from DBE and aid the endoscopist in choosing the most efficient route.

Background: Jejunal diverticular disease is a rare cause of gastrointestinal bleeding. The reported incidence of this disease is low in the studies of double-balloon enteroscopy., Aim: The aim of this study was to evaluate the clinical features and management of jejunal diverticular disease, diagnosed by double-balloon enteroscopy, at our institution., Method: This was a retrospective study of patients with jejunal diverticular disease conducted from April 2004 to September 2009 at Changhua Christian Hospital. We evaluated the clinical significance of jejunal diverticular disease and the outcome of endoscopic treatment for jejunal diverticular bleeding., Results: From April 2004 to September 2009, a total of 55 patients underwent double-balloon enteroscopy due to obscure gastrointestinal bleeding. Fifteen of these patients were diagnosed with jejunal diverticular disease (8 men and 7 women, mean age 71 years). Four patients were found to have a single diverticulum. Gastrointestinal bleeding was attributed to jejunal diverticular disease in 12 patients. Six patients received endoscopic treatment in order to achieve hemostasis. One patient received emergency surgery due to uncontrolled bleeding., Conclusions: To our knowledge, this is the first study reporting the clinical significance of jejunal diverticular disease diagnosed by double-balloon enteroscopy. We found that obscure GI bleeding was attributed significantly to jejunal diverticular disease.

Vascular lesions in the small bowel with bleeding complications are usually difficult to diagnose and localize preoperatively. With the increased use of either capsule endoscopy or enteroscopy, there have been more reports of preoperative diagnosis from such lesions. The authors report a rare case of obscure gastrointestinal bleeding from a combined hemangioma and angiodysplasia identified by double-balloon enteroscopy. To the authors' knowledge, this is the first report of such combined lesions., (2010 Elsevier Inc. All rights reserved.)

In this article, we report a case study of a 54-year old man who presented with massive gastrointestinal bleeding. Esophagogastroduodenoscopy and colonoscopy had been performed in another hospital, but the location of the bleeding could not be identified, and the patient was transferred to our hospital. An initial abdominal computed tomography scan showed only a large blood clot in the small bowel and colon, with duodenojejunal diverticulosis. Emergent angiography was performed due to persistent active bleeding. Active bleeding from the jejunum was found, and the patient received a double balloon enteroscopy, which disclosed active bleeding in one of the jejunal diverticula. Two hemoclips were applied to treat the Dieulafoy's lesion within the diverticulum. The patient had no bleeding during the month following treatment. Bleeding of the jejunal diverticulum is a rare clinical condition, and only a few cases have been reported in the literature with successful endoscopic treatment. A short review of the current methods of diagnosis and treatment of this rare disorder is provided.

Dieulafoy lesion is an uncommon cause of acute gastrointestinal bleeding. The diagnosis is usually carried out endoscopically. We report a 77-year-old woman with rectal Dieulafoy lesion. A recent endoscopic examination missed the lesion because it was small and the bleeding was intermittent. In our case, prompt colonoscopic therapy was allowed after locating the bleeder by multidetector-row computed tomography. On the basis of the success of this procedure, we suggest that an emergent multidetector-row computed tomography could have a role in the management of patients with massive lower gastrointestinal bleeding.

Background: Duodenal diverticulum (DD) is a rare cause of upper-GI bleeding. The diagnosis and treatment of DD bleeding (DDB) is challenging. Surgical management was the mainstay of therapy before the 1990s., Objective: To evaluate the clinical feature, diagnosis, and management of cases of DDB at our institution and the literature after the first description of endoscopic therapy of this disease., Design: Retrospective single-center clinical review., Setting: Primary- and tertiary-care centers., Patients: A retrospective study of patients with DDB from January 2000 to January 2005 at Changhua Christian Medical Center., Main Outcome Measurements: Diagnostic yield and therapy results of endoscopy on DDB., Results: At our institution, from January 2000 to January 2005, a total of 11 patients (4 men and 7 women, mean age 75 years) were found to have DDB. The diverticulum was located in the second portion (n = 10) and the third portion (n = 1). Endoscopy was used as the diagnostic method in all of these cases and as the therapeutic method in 72.73% of these cases. None of our patients experienced recurrent bleeding., Limitations: The study is limited to the small case number and was retrospective., Conclusions: To our knowledge, this is the first report and the largest series that studied endoscopic management of DDB in the literature. We concluded that endoscopy is useful to diagnose and treat patients with DDB.

Background and Aims. Patients with Meckel's diverticulum (MD) are difficult to preoperatively diagnose because of its endoscopic inaccessibility. Balloon-assisted enteroscopy (BAE) allows endoscopic access to the entire small intestine. The aim of the current study was to investigate patients with MD diagnosed by BAE in Taiwan. Methods. We conducted a retrospective, multicenter study of patients with MD who were diagnosed by BAE in Taiwan. The clinical characteristics, endoscopic features, histopathological findings, treatment methods, and outcomes were analyzed. Results. A total of 55 patients with MD were enrolled (46 males and 9 females). The mean age at diagnosis was 34.1 years. Overt gastrointestinal bleeding (87.3%) was the primary indication for BAE, followed by abdominal pain (9.1%), suspected small bowel tumor (1.8%), and Crohn's disease follow-up (1.8%). The mean distance between the ileocecal valve and MD was 71.6 cm (regarding diagnostic yields: BAE—100%, capsule endoscopy—40%, Meckel's scan—35.7%, computed tomography—14.6%, small bowel series—12.5%, and angiography—11.1%; regarding endoscopic features of MD: a large ostium—89.1%, a small ostium—7.3%, and a polypoid mass—3.6%). Surgical treatment was performed in 76.4% patients, and conservative treatment was performed in 23.6% patients. The mean length of MD in 42 patients who underwent surgical resection was 5.2 cm (in 43 patients of MD with available histopathology: heterotopic gastric tissue, 42.4%, heterotopic gastric and pancreatic tissues, 7%; heterotopic pancreatic tissue, 4.7%; heterotopic colonic tissue, 2.3%; and a neuroendocrine tumor, 2.3%). Conclusions. The current study showed BAE is a very useful modality for detecting MD compared with other conventional modalities. [ABSTRACT FROM AUTHOR]

B Video 1 b Capsule endoscopy of an 84-year-old woman, showing a bleeding polypoid lesion in the jejunum. In this case, the bleeding intestinal lymphangioma was successfully diagnosed by capsule endoscopy and treated by resection during enteroscopy. [Extracted from the article]

A follow-up abdominal computed tomography (CT) scan performed 6 months ago revealed absence of tumour recurrence. Subsequent abdominal CT revealed a 2-cm hypervascular tumour (Fig., arrow) of the small bowel. 2007; 7: 4. 4 Ko M-Y, Yen C-E, Yen H-H. Obscure gastrointestinal bleeding with negative abdominal computed tomography study: the importance of enteroscopy for early diagnosis of small bowel malignancy. [Extracted from the article]

Although the majority of colonic lipomas are asymptomatic, some complications such as haemorrhage[1] and intussusception may develop from large lipomas and require surgical excision. The present case is interesting as we did not observe typical endoscopy findings of colonic lipoma.[4] Instead, we observed a new sign of colonic lipoma after intussusception, that is, a bloodless, shiny, ball-like leading point with a twisting base. The bloodless, shiny, ball-like lesion exposed the submucosal adipose tissue with complete necrosis of the overlying mucosa after intussusception. [Extracted from the article]