{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T04:22:26Z","timestamp":1787458946582,"version":"build-2736575974"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"vor","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Gastrointestinal (GI) bleeds can pose significant life-threatening situations if not identified promptly, progressing to hemorrhagic shock. We discuss the case of a 60-year-old man presenting with an elusive GI bleed. Esophagogastroduodenoscopy, colonoscopy, Meckel\u2019s scan, and computed tomographic angiography were performed, which yielded no active bleed despite active hemorrhage. As a result, double-balloon computed tomography enterography was performed, demonstrating jejunal diverticula with angiodysplasia and arteriovenous malformations (AVMs), suspected to be the source of the elusive GI bleed. Clips were attempted at the sites of visible AVMs, but were unsuccessful. The diverticula were tattooed with a plan for an exploratory laparotomy for definitive treatment. The patient was ultimately discharged with no signs of active bleeding and an uncomplicated recovery. This case highlights the multifactorial management of a massive GI bleed with no identifiable source of bleeding upon admission, progressing into hemorrhagic shock.<\/jats:p>","DOI":"10.1093\/jscr\/rjag733","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T11:55:48Z","timestamp":1786017348000},"source":"Crossref","is-referenced-by-count":0,"title":["Discovery and management of arteriovenous malformation with jejunal diverticulum: elusive gastrointestinal bleed"],"prefix":"10.1093","volume":"2026","author":[{"given":"Annetta","family":"Panayides","sequence":"first","affiliation":[{"name":"School of Medicine, St. George\u2019s University, University Centre, True Blue, St. George's, Grenada , West Indies"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maeve E","family":"Tremis","sequence":"additional","affiliation":[{"name":"School of Medicine, St. George\u2019s University, University Centre, True Blue, St. George's, Grenada , West Indies"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hackensack Meridian Health, Jersey Shore University Medical Center , Neptune, NJ 07756 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn S","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hackensack Meridian Health, Jersey Shore University Medical Center , Neptune, NJ 07756 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"key":"2026082300184831600_ref1","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1038\/ajg.2015.246","article-title":"ACG clinical guideline: diagnosis and management of small bowel bleeding","volume":"110","author":"Gerson","year":"2015","journal-title":"Am J Gastroenterol"},{"key":"2026082300184831600_ref2","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1055\/s-2005-870319","article-title":"ICCE consensus for obscure gastrointestinal bleeding","volume":"37","author":"Pennazio","year":"2005","journal-title":"Endoscopy"},{"key":"2026082300184831600_ref3","doi-asserted-by":"publisher","first-page":"2720","DOI":"10.3748\/wjg.v25.i22.2720","article-title":"Diagnosis and therapeutic strategies for small bowel vascular lesions","volume":"25","author":"Sakai","year":"2019","journal-title":"World J Gastroenterol"},{"key":"2026082300184831600_ref4","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1148\/radiol.11110143","article-title":"Prospective blinded comparison of capsule endoscopy and multiphase CT enterography in obscure gastrointestinal bleeding","volume":"260","author":"Huprich","year":"2011","journal-title":"Radiology"},{"key":"2026082300184831600_ref5","first-page":"822","article-title":"Diagnostic yield of dual-phase CT enterography in patients with obscure gastrointestinal bleeding and negative capsule endoscopy","volume":"199","author":"Agrawal","year":"2012","journal-title":"AJR Am J Roentgenol"},{"key":"2026082300184831600_ref6","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.1097\/00007611-198811000-00013","article-title":"Surgical implications of jejunal diverticula","volume":"81","author":"Wilcox","year":"1988","journal-title":"South Med J"},{"key":"2026082300184831600_ref7","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1016\/j.ajem.2019.06.034","article-title":"The impact of a multidisciplinary algorithmic approach to acute lower gastrointestinal bleeding","volume":"37","author":"Petersile","year":"2019","journal-title":"Am J Emerg Med"},{"key":"2026082300184831600_ref8","first-page":"S8","article-title":"An algorithmic approach to gastrointestinal bleeding in patients receiving antithrombotic agents","volume":"13","author":"Sadeghi","year":"2020","journal-title":"Gastroenterol Hepatol Bed Bench"},{"key":"2026082300184831600_ref9","first-page":"S-1149","article-title":"Multiphase CT enterography in the evaluation of small bowel bleeding: diagnostic yield and clinical outcomes","volume":"156","author":"Deepak","year":"2019","journal-title":"Gastroenterology"},{"key":"2026082300184831600_ref10","first-page":"216","article-title":"Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding","volume":"267","author":"Garc\u00eda-Bl\u00e1zquez","year":"2013","journal-title":"Radiology"},{"key":"2026082300184831600_ref11","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.giec.2023.09.006","article-title":"Diagnosis of occult and obscure gastrointestinal bleeding","volume":"34","author":"Thakral","year":"2024","journal-title":"Gastrointest Endosc Clin N Am"},{"key":"2026082300184831600_ref12","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1016\/j.gie.2008.03.1062","article-title":"Diagnostic yield of double-balloon endoscopy in patients with obscure GI bleeding","volume":"68","author":"Tanaka","year":"2008","journal-title":"Gastrointest Endosc"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/8\/rjag733\/70765196\/rjag733.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/8\/rjag733\/70765196\/rjag733.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T04:18:53Z","timestamp":1787458733000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjag733\/8768857"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":12,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8,4]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjag733","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,8]]},"article-number":"rjag733"}}