Endoscopic diagnosis of upper gastrointestinal tract bleeding from a duodenal diverticulum

Abstract

The clinical significance of duodenal diverticula has been a matter of controversy for many years. Although most diverticula are innocuous, over the last two decades various studies have established an association with biliary tract and pancreatic disease. I 4 Also, multiple reports have appeared describing life-threatening situations related to duodenal diverticula, e.g., perforation, cholecystitis, intestinal obstruction, and massive hemorrhage.5-8 Bleeding from a duodenal diverticulum can be caused by erosion into a vessel such as the aorta or a mesenteric vessel, by bleeding ectopic gastric mucosa, or from a local inflammatory process.12 A rare case of bleeding from an intradiverticular polyp has also been documented. This potentially lethal complication is usually diagnosed only at laparotomy. We report a case in which the diagnosis of upper gastrointestinal tract bleeding from a duodenal diverticulum was made preoperatively with endoscopy. Considerations regarding management and surgical approach are discussed.