Diagnosis of jejunal tubular duplication by enteroscopy in an adult female with recurrent gastrointestinal bleeding

Intestinal duplication, uncommon in adulthood, is a rare congenital deformity that mainly occurs in the ileum ¹ . It can be divided into two types: cyst and tubular. The diagnosis of intestinal duplication is challenging due to its atypical symptoms and limitations of current imaging techniques ² .

A 57-year-old woman presented with recurrent melena for 1 month. Routine blood tests revealed a decreased hemoglobin level of 73g/L (reference range: 115–150 g/L). Neither upper endoscopy nor colonoscopy revealed obvious findings, suggesting suspected small bowel bleeding. An abdominal computed tomography enterography demonstrated no evident abnormality. Capsule endoscopy showed a protruding lesion with active bleeding in the upper jejunum ( Fig. 1 ). A subsequent transoral double-balloon enteroscopy was performed, achieving a complete, unidirectional examination of the entire small bowel.

Fig. 1.

A capsule endoscopic image showing a protruding lesion (white arrow) with active bleeding in the proximal jejunum.

We spotted a triple-lumen appearance along with exposed swollen blood vessels ( Fig. 2 ) at the proximal part of jejunum. Closer observation of the triple-lumen structure found a diverticular opening and two separate, distinct lumina ( Fig. 3 ) within the small intestine, both open to the distal end of the jejunum ( Video 1 ), suggesting intestinal tubular duplication. No abnormalities were detected in the rest of the jejunum and the ileum. Partial surgical resection of the small intestine was performed for the patient, revealing a 3 cm × 2 cm tubular structure resembling a smaller intestine attached to the bowel wall of the main jejunum ( Fig. 4 ). Pathology of the surgical specimen exhibited the presence of intestinal mucosa and submucosa inside the tubular lesion, confirming the the diagnosis of intestinal duplication.

Fig. 2.

An endoscopic image showing exposed swollen blood vessels (white arrow) near the triple-lumen structure.

Fig. 3.

An endoscopic image showing the triple-lumen structure including the diverticular opening (red arrow), the duplicate lumen (yellow arrow) and the main lumen (white arrow).

Fig. 4.

A surgical specimen showing a 3 × 2 cm tubular structure attached to the bowel wall of the jejunum.

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Diagnosis of small bowel tubular duplication with enteroscopy.

Video 1

In this case, we successfully diagnosed a jejunal tubular duplication causing gastrointestinal bleeding in an adult using trans-oral enteroscopy. This highlights the significance of enteroscopy in identifying rare and complex small intestinal lesions with atypical symptoms, especially when regular imaging studies or capsule endoscopy fail to make a diagnosis.

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