A 60-year-old male patient, with no relevant past medical history, presented to the emergency department with a history of gastrointestinal bleeding in the form of hematochezia, normal temperature, vomiting or heart rate, with hemodynamic stability (blood pressure 831/61 mmHg)
Analytical at admission: Hb 11.3 g/dl, Hto 33.1%, V 89 fL, urea 11/L and creatinine 67 μmol/L. Initially, an objective fibrogastroscopy lesion was performed without bleeding.
During admission, the patient developed progressive anemia (Hb. Hb 7 g/dl), requiring transfusion of 5 solids.
On the fourth day of admission, the patient developed several episodes of hematochezia with transient hemodynamic instability.
A new fibrogastroscopy was performed without locating the cause of the bleeding.
Due to the persistence of bleeding (which required volume expansion with crystalloids and transfusion of 11 additional concentrates/dose), arteriography was performed trans celiac artery and extrafemoral artery dependent celiac trunk and inferior mesenteric artery.
Selective catheterization and embolization with microcoils was performed and the supraethylene septate microcatheter (2.7 Fr) was maintained in situ for subsequent identification of the pathological jejunal blue segment by intraoperative administration.
An urgent exploratory laparotomy was performed with multiple jejunal diverticula.
Methylene blue (0.5 ml) is administered through the microcatheter, identifying a segment of the jejunum stained with blue at 1 meter from the Treitz angle that includes the lesion responsible for the bleeding (diverticle).
Segmental intestinal resection of 20 centimeters of the loop and anastomosis were performed.
A simple X-ray of the surgical specimen showed multiple sclerosis and microcoils near the diverticulum responsible for bleeding.
The patient presented with respiratory distress in the immediate postoperative period (secondary to polytransfusion and hypovolemic shock state), affecting the intensive care unit for 10 days.
Subsequent course was uneventful and the patient was discharged 17 days later.
Pathology confirmed the diagnosis of focal and jejunal ulceration.
