CT Angiography for the Diagnosis of Hemorrhagic Jejunal Diverticulosis: A Rare Cause of Obscure GI Bleeding

Jejunal diverticulosis (JD) is a rare condition of the small intestine characterized by acquired pseudodiverticula arising along the mesenteric border. Although most cases remain asymptomatic, complications may occur in a minority of patients and include diverticulitis, perforation, intestinal obstruction, malabsorption, and, more rarely, GI hemorrhage. Bleeding originating from jejunal diverticula is an uncommon but potentially life-threatening cause of obscure GI bleeding (OGIB). We report the case of a 59-year-old woman who presented to the ED with melena associated with symptomatic anemia. Initial gastroduodenal endoscopy failed to identify a source of bleeding. Subsequently, contrast-enhanced CT angiography of the abdomen was performed and demonstrated multiple jejunal diverticula. One diverticulum contained spontaneous hyperdense material on non-contrast images, compatible with intraluminal blood, and was associated with a dilated submucosal vascular structure, suggesting the site of recent hemorrhage. JD is a rare but important cause of OGIB. When endoscopic investigations are inconclusive, CT angiography plays a crucial role in identifying the bleeding source and guiding management. Awareness of this entity and its imaging features is essential for radiologists and clinicians involved in the evaluation of GI hemorrhage.