Endoscopic management of duodenal diverticular bleeding
Although the presence of a duodenal diverticulum is usually asymptomatic, bleeding in this tissue is sometimes difficult to diagnose and treat. To investigate the strategy for treatment, we reviewed the clinical data of patients diagnosed and treated for duodenal diverticular bleeding. Retrospective case series. Single tertiary-referral center. Seven consecutive patients with bleeding from a duodenal diverticulum (mean age, 73.7 +/- 3.4 years old). The clinical characteristics, endoscopic findings, and treatment strategy for duodenal diverticular bleeding. All 7 patients achieved hemostasis. Six of 7 patients were treated endoscopically. There were no complications with endoscopic treatment. Three patients bled from diverticula located at the second portion of the duodenum, and 4 patients bled from that located at the third portion. In 6 of 7 patients, lesions were identified and treated endoscopically with hemoclips, hypertonic saline solution and epinephrine (HSE), and/or 1% polidocanol injection. In 1 case, the lesion could not be detected during the first endoscopic examination, and the patient, therefore, was treated with transarterial embolization followed by surgical resection. This preliminary case series described the feasibility of the endoscopic treatment. However, optimal management, including angiography and/or surgery, should be individualized to the patients, location, and type of hemorrhage. Bleeding from a duodenal diverticulum should be considered in the case of upper-GI bleeding of unknown origin. An endoscopy may be an effective alternative to surgery in the management of a bleeding duodenal diverticulum.
- "Currently, no guidelines exist on the optimal therapeutic approach to manage a bleeding diverticulum. Treatment options include endoscopic techniques to achieve hemostasis, selective arterial embolization and surgical management [2, 3, 10] . The first case of endoscopic hemostasis of duodenal diverticula bleeding was reported in 1991 by Sim et al . "
[Show abstract] [Hide abstract] ABSTRACT: Bleeding duodenal diverticulum is a rare cause of gastrointestinal bleeding, which sometimes can be massive and life threatening. We report one such case and the management, with a successful outcome. Different diagnostic techniques and management options available are also discussed.0Comments 8Citations
- "It may be necessary to perform both investigations since the failed visualization of the diverticulum with one investigation does not exclude the presence of a duodenal diverticulum . Treatment options include endoscopic haemostasis, endoscopic incision and ligation of the diverticulum, embolization and surgery8910. Usefulness of endoscopic techniques as a definitive procedure is limited due to the high incidence of re-bleeding  . "
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