Multiple Duodenal Diverticula: A Rare Cause of Massive Upper Gastrointestinal Bleeding and Hemodynamic Instability

Nneoma Okoronkwo, Sami Samiullah, Gustavo Churrango, Weizheng Wang

Abstract


Duodenal diverticula are usually asymptomatic and identified incidentally on imaging studies. In this report, we present a case of massive gastrointestinal (GI) bleeding from multiple duodenal diverticula. A 43-year-old man was evaluated for lightheadedness, hematemesis, and melena. Patient was hypotensive and resuscitated with intravenous fluids and blood products. Upper endoscopy revealed multiple diverticula in the bulb, sweep and second portion of the duodenum with active bleeding from specific diverticulum. Epinephrine was injected around the bleeding diverticulum and multiple endoclips were applied. Patient continued to have persistent melena and required multiple units of packed red blood cells. Repeat endoscopy showed active bleeding from another duodenal diverticulum controlled with endoclips. Patient still had persistent bleeding, thus angiography was performed. Celiac artery stenosis was visualized with poststenotic dilatation. Embolization of the gastroduodenal artery could not be performed due to its retrograde flow supplying the hepatic artery proper. Patient underwent exploratory laparotomy with no further bleeding visualized through a gastrostomy. Duodenum diverticulum is a rare cause of massive upper GI hemorrhage. Endoscopy might not be successful in identifying the bleeding site. There is a high incidence of re-bleeding with endoscopic interventions. Surgery remains the definitive treatment in cases with life-threatening hemorrhage.




J Med Cases. 2015;6(10):444-446
doi: http://dx.doi.org/10.14740/jmc2229w

Keywords


Diverticulum; Gastrointestinal hemorrhage; Upper gastrointestinal tract; Hemostasis

Full Text: HTML PDF
 

Browse  Journals  

     

Journal of clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 

 

 

 

Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.            
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.journalmc.org   editorial contact: editor@journalmc.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.