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Open Access Highly Accessed Case report

Active bleeding from a periampullary duodenal diverticulum that was difficult to diagnose but successfully treated using hemostatic forceps: a case report

Noriko Nishiyama1*, Hirohito Mori1, Kazi Rafiq2, Hideki Kobara1, Shintarou Fujihara1, Mitsuyoshi Kobayashi1 and Tsutomu Masaki1

Author Affiliations

1 Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Miki, Kagawa, Kita, 761-0793, Japan

2 Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Miki, Kagawa, Kita, 761-0793, Japan

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Journal of Medical Case Reports 2012, 6:367  doi:10.1186/1752-1947-6-367

Published: 26 October 2012

Abstract

Introduction

Although duodenal diverticula are common, periampullary duodenal diverticula are rare. Periampullary duodenal diverticula are usually asymptomatic and may be difficult to diagnose and treat. However, they may present with massive bleeding, requiring prompt diagnosis.

Case presentation

We report the case of a 71-year-old Asian woman with bleeding from a periampullary duodenal diverticulum. She presented with severe anemia and tarry stools. Two examinations using a forward-viewing endoscope did not identify the source of the bleeding. However, examination using a side-viewing endoscope found an exposed bleeding vessel overlying the bile duct within a periampullary diverticulum of the descending part of the duodenum. The bleeding was successfully controlled by using hemostatic forceps.

Conclusions

Bleeding periampullary duodenal diverticula are rare, and a bleeding point in the mucosa overlying the bile duct within a large periampullary duodenal diverticulum is very rare. Identification of a bleeding point within a duodenal diverticulum often requires repeated examination and may require the use of a side-viewing endoscope. Use of hemostatic forceps to control bleeding from a periampullary duodenal diverticulum is very rare but, for bleeding lesions overlying the bile duct within a periampullary duodenal diverticulum, is the best way to prevent obstructive jaundice.

Keywords:
Bleeding periampullary duodenal diverticulum; Side-viewing endoscopy; Hemostatic forceps; Obscure gastrointestinal bleeding