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Massive bleeding from a duodenal diverticulum successfully treated with transarterial embolization and endoscopic coagulation
Author(s) -
Inoue Takao,
Nakazawa Saburo,
Hattori Toshiyuki,
Katayama Makoto,
Taki Tomoyuki,
Takashima Toshin,
Inui Kazuo
Publication year - 2004
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2004.00300.x
Subject(s) - medicine , embolization , diverticulum (mollusc) , surgery , hemostasis , complication , endoscopy , asymptomatic , angiography , electrocoagulation , radiology , gastroduodenal artery , transarterial embolization , artery
Duodenal diverticula are common in adults, but are usually asymptomatic. Massive hemorrhage is a rare, but potentially lethal, complication that can be difficult to diagnose and treat. A 21‐year‐old woman was referred with duodenal hemorrhage of uncertain origin. Endoscopy revealed a duodenal diverticulum, but a discrete bleeding source was not identified. Transarterial embolization via the posterior pancreaticoduodenal artery decreased bleeding to where endoscopic electrocoagulation could be used effectively to stop all blood loss. Initial management of duodenal diverticular hemorrhage should be endoscopic. If unsuccessful, transarterial embolization should be attempted. When bleeding is slowed, but not arrested completely by embolization, endoscopic coagulation should be attempted again before surgery is undertaken. Advances in endoscopic hemostasis and angiography allow patients with bleeding duodenal diverticula to be managed non‐operatively in some cases.