A Case of Bleeding Ulcer of the Jejunum Successfully Treated with Colonoscopic Clipping

We report herein a rare case of bleeding jejunal ulcer successfully treated with colonoscopic clipping. A 57-year-old man underwent Hartmann's operation for perforation of cancer of the rectosigmoid. He developed disseminated intravascular coagulopathy and septis by mechycilin resistant staphylococcus aureus postoperatively. Twelve days after the operation, he suddenly presented with melena which resulted in hypovolemic shock. Emergency angiography revealed extravasation from the branch of the jejunal artery. Hemostasis of the jejunal lesion was achieved by transarterial embolization using gelatine sponge. Five days after the embolization, he presented with melena again. A colonoscope was introduced into the jejunum perorally. An arterially bleeding small ulcer located 25 cm distally from the Treitz's ligament was successfully clipped. Although he died of hypercalcemia 43 days after the operation, no bleeding from the ulcer was seen until death. Our experience suggests that colonoscopic clipping is one of the effective methods of hemostasis for bleeding ulcer of the upper jejunum especially in poor-risk patients.