A 60-year-old male patient with no history of pathology of interest came to the emergency department for gastrointestinal bleeding in the form of haematochezia, without haematemesis, with haemodynamic stability (blood pressure 101/61 mmHg, heart rate 83 beats/min, temperature 36.8 ºC) and normal physical examination. Laboratory tests on admission: Hb 11.3 g/dl, Ht 33.1%, MCV 89 fL, urea 11 mmol/L and creatinine 67 µmol/L. Initially, fibrogastroscopy and colonoscopy were performed, but no lesion responsible for the bleeding was found. During admission, the patient became progressively anaemic (up to Hb 7 g/dl), requiring transfusion of 5 red blood cell concentrates. On the fourth day of admission he presented several episodes of haematochezia with transient haemodynamic instability. A new fibrogastroscopy and colonoscopy were performed, without locating the cause of the haemorrhage. Given the persistence of the bleeding (which required volume expansion with crystalloids and transfusion of 11 additional red blood cell concentrates), transfemoral arteriography of the celiac trunk and superior and inferior mesenteric artery was performed, revealing intraluminal extravasation of contrast depending on a proximal jejunal artery. Selective catheterisation and embolisation with microcoils was performed and the supraselective microcatheter (2.7 Fr) was kept in situ for subsequent identification of the pathological jejunal segment by intraoperative administration of methylene blue through it. An urgent exploratory laparotomy was performed, which revealed multiple jejunal diverticula. Methylene blue (0.5 ml) was administered through the microcatheter, identifying a segment of jejunum stained blue 1 metre from the angle of Treitz that included the lesion responsible for the haemorrhage (jejunal diverticulum). A segmental bowel resection of 20 centimetres of jejunum was performed, as well as a lateral-lateral anastomosis. A plain X-ray of the surgical specimen showed the presence of multiple diverticulosis and microcoils close to the diverticulum responsible for the bleeding. The patient presented with respiratory distress in the immediate postoperative period (secondary to polytransfusion and hypovolemic shock), and remained in the Intensive Care Unit for 10 days. Subsequent course was uneventful, and he was discharged from hospital 17 days later. Pathological anatomy confirmed the diagnosis of jejunal diverticulosis with focal ulceration.

