A CASE OF HEMORRHAGIC JEJUNAL DIVERTICULUM CONTAINING ECTOPIC GASTRIC MUCOSA, WITH ENDOSCOPICALLY OBSERVED INVERSION AND SPONTANEOUS REDUCTION

Abstract

Herein, we describe a rare case of a hemorrhagic jejunal diverticulum containing ectopic gastric mucosa. A 27-year-old woman was admitted to our hospital with a history of tarry stools and dizziness. She had experienced anemia-induced syncope at the age of 24 years, at which time esophagogastroduodenoscopy (EGD) and colonoscopy had revealed no abnormalities. On admission, her hemoglobin level was 6.9 g/dL. Computed tomography of the abdomen showed a tumorous lesion measuring 25 mm in diameter in the proximal jejunum, that showed staining with contrast material. EGD revealed a protruding lesion in the proximal jejunum, and oozing of blood was observed from the surface of the lesion. Pathological examination of the biopsy specimens revealed the presence of granulated tissue. In the EGD examination performed 4 months later, the protruding lesion was found to have almost disappeared and the formation of a deep recess with elevation of the margins was observed. Subsequently, surgery was undertaken. During the operation, a smooth red-colored protrusion was observed on the anti-mesenteric side located 2 cm distal from the ligament of Treitz ; accordingly, wedge resection of the jejunum was performed. Pathological analysis of the resected specimen revealed a true diverticulum of the jejunum containing ectopic gastric mucosa. Retrospective inspection of the protruding lesion that was observed endoscopically at admission suggested inversion of the diverticulum, and the formation of a deep recess observed 4 months later seemed to represent spontaneous reduction of the inverted diverticulum.