Colonoscopic diagnosis of unsuspected diverticulosis.
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Angiography has greatly improved the precision of diagnosis of massive lower gastrointestinal bleeding in elderly patients. This, in turn, has permitted a more conservative approach, even when operative management becomes necessary. It bears emphasis, however, that hematochezia in elderly patients is usually relatively benign and tends to cease spontaneously. An overly enthusiastic diagnostic or therapeutic course is not warranted, and conservative control of the acute episode, followed by sufficient evaluation to rule out malignancy, is probably all that is necessary. When massive bleeding becomes persistent or recurrent, however, it is clearly life threatening, and a vigorous diagnostic and therapeutic program should be initiated promptly.
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Small intestinal obstruction caused by enteroliths originating in jejunal diverticula is rare. We present our experience with three elderly female patients who were successfully treated for this condition. The diagnosis, in all three cases, was made on laparotomy. Two patients underwent enterolithotomy while the third, who had a acutely inflamed jejunal diverticulum, had a jejunal resection.
Occult gastrointestinal bleeding frequently frustrates clinicians' attempts to locate the source. Foci of hemorrhage within the small bowel are often found only at laparotomy and can be attributed to Meckel's diverticula, carcinomas, or less frequently, pulsion-type diverticula. We report our experience with two patients whose jejunal diverticula resulted in recurrent episodes of massive gastrointestinal hemorrhage.
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