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. 2022 Jan 17;8(1):11.
doi: 10.1186/s40792-022-01363-3.

Transcatheter arterial embolization followed by surgical laparotomy for hemorrhagic shock due to intestinal bleeding: a case report

Sayumi Kurita  1 , Kazuo Kitagawa  2 , Naoki Toya  2 , Mutsumi Kaji  2 , Satoshi Yoshioka  2 , Yuki Hiramoto  2 , Shuichi Fujioka  2 , Naoto Takahashi  2 , Ken Eto  3
Affiliations

Transcatheter arterial embolization followed by surgical laparotomy for hemorrhagic shock due to intestinal bleeding: a case report

Sayumi Kurita et al. Surg Case Rep. .

Abstract

Background: Acquired jejunal diverticula are relatively rare conditions. While mostly asymptomatic, they can occasionally cause life-threatening complications requiring surgical treatment. We herein report a case of hemorrhagic shock due to jejunal diverticulum with intestinal amyloidosis that was successfully managed via transcatheter arterial embolization (TAE) and surgery.

Case presentation: An 80-year-old female presenting with hematochezia and hemorrhagic shock was transferred to our institution. Contrast-enhanced computed tomography revealed extravasation in the small bowel around the upper jejunum. Massive transfusion was performed with subsequently planning for TAE to control bleeding followed by surgical laparotomy to evaluate the ischemic intestine. First, the second jejunal artery was selectively embolized with a 1:3 mixture of N-butyl cyanoacrylate (NBCA) and iodize oil, after which laparotomy was performed. Multiple jejunal diverticula were detected near Treitz' ligament, and an induration of NBCA was palpable in the nearby mesentery. The intraoperative diagnosis was massive bleeding from acquired jejunal diverticula for which jejunectomy including the nearby diverticulum was performed to prevent future bleeding. Her postoperative course was stable. Histological examination of the specimen revealed several false diverticula with intestinal amyloidosis.

Conclusion: Hemorrhagic shock due to jejunal diverticulum with intestinal amyloidosis is extremely rare. Combined treatment of TAE and surgical laparotomy appears to be effective, because the bleeding point can be identified by palpation of the embolic material.

Keywords: Hemorrhagic shock; Intestinal amyloidosis; Intestinal bleeding; Jejunal diverticula; Transcatheter arterial embolization.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Contrast-enhanced computed tomography of the abdomen. a Early phase. b Delayed phase. Arrow: extravasation around the upper jejunum
Fig. 2
Fig. 2
Angiography findings. a Second jejunal artery (black arrow) was visualized using a contrast medium. Contrast medium leakage from the peripheral artery of the second jejunal branch (white allow). b Second jejunal artery (black arrow) was embolized with N-butyl cyanoacrylate. c Leakage disappeared
Fig. 3
Fig. 3
Histological examination of the specimen. a With macroscopic findings showed several many false diverticula. b Organized vein opened into the diverticula. c Microscopic findings revealed glass-like acidophilic unstructured deposits around the vein wall. d Glass-like structure was stained orange with DFS staining, which suggested intestinal amyloidosis
See this image and copyright information in PMC

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