Year 2022 / Volume 114 / Number 3
Letter
Upper gastrointestinal bleeding due to duodenum diverticulum: a challenge for the endoscopist

179

DOI: 10.17235/reed.2021.8373/2021

Asunción Ojeda Gómez, Alicia Brotons Brotons, Almudena María Íñigo Chaves, Javier Sola Vera Sánchez, Jorge Barragán Martínez, Andrea García Soria, Julia Sáez Fuster, Mariana Fe García Sepulcre,

Abstract
An 80-year-old female with a mechanic mitral valve treated with acenocumarol was admitted to the hospital due to tarry stools over the last two days and hemoglobin levels of 5.6 g/dl. She had not biliary pathology. An emergency esophagogastroduodenoscopy showed lots of fresh clots over the second part of the duodenum that seemed to come from the major papilla. A duodenoscopy was performed in order to obtain a direct view, showing a huge clot near the papilla. Its removal with a polypectomy snare revealed a large duodenum diverticulum with little saculations inside, one of which showed a visible, actively bleeding vessel. Sclerosis with epinephrine was performed and subsequently, two through-the-scope Cook® 11 mm clips were placed, achieving the cessation of the hemorrhage. Several attempts with different clips were needed since they were separated by the elevator nail of the duodenoscope. No complications developed during the procedure or once anticoagulation was restarted.
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References
1. Donald JW. Major complications of small bowel diverticula. Ann Surg 1979;190:183-8. DOI: 10.1097/00000658-197908000-00011
2. Esteban MJ, Sureen A, Herlihy D et al. Massive Hematochezia from a Large Bleeding Duodenal Diverticulum. Case Rep Gastrointest Med. 2021 Jun 8;2021:5585264.
3. Oukachbi N, Brouzes S. Management of complicated duodenal diverticula. J Visc Surg 2013;150(3):173-179. doi: 10.1016/j.jviscs2013.04.006
4. Ogasawara N, Kikuchi D, Tanaka M et al. Hemostasis achieved endoscopically for duodenal diverticular bleeding by removing a large blood clot using a snare. Clin J Gastroenterol. 2020 Aug; 13(4):615-620.
DOI: 10.17235/reed.2017.4755/2016
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Citation tools
Ojeda Gómez A, Brotons Brotons A, Íñigo Chaves A, Sola Vera Sánchez J, Barragán Martínez J, García Soria A, et all. Upper gastrointestinal bleeding due to duodenum diverticulum: a challenge for the endoscopist. 8373/2021


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Publication history

Received: 06/10/2021

Accepted: 24/10/2021

Online First: 03/11/2021

Published: 07/03/2022

Article revision time: 17 days

Article Online First time: 28 days

Article editing time: 152 days


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