Massive Hematochezia from a Large Bleeding Duodenal Diverticulum

Abstract

Background. Duodenal diverticula are a rare cause of gastrointestinal (GI) bleeding despite being a common finding in the GI tract. We present a case of a patient who had massive hematochezia due to a complex duodenal diverticulum. Case Presentation. A 74-year-old Hispanic female presented initially with generalized weakness. During admission, the patient had an episode of a large amount of hematochezia and had to be transferred to the intensive care unit (ICU). Upper endoscopy was done using a forward-viewing endoscope which revealed a bleeding complex duodenal diverticulum. Successful hemostasis was achieved through epinephrine injection followed by placement of hemostatic clips. Conclusion. Although rare, gastroenterologists need to be aware of duodenal diverticulum as a possible cause of gastrointestinal bleed. It could be life-threatening, and thus, prompt diagnosis and management is necessary.

An Uncommon Case of Intraluminal Duodenal Diverticulum Complicated by Recurrent Gastrointestinal Bleeding and Small Bowel Obstruction

“…IDD or "windsock" diverticulum is a rare congenital malformation arising from an incomplete recanalization of the foregut during the 4-8th week of embryogenesis resulting in a duodenal diaphragm or web [1][2][3]. Over time, peristaltic forces lead to progressive ballooning of the tissue forming a diverticulum within the lumen.…”

“…She was treated with epinephrine injection (3/10,000), two hemoclips, and high-dose Protonix. With the advances in endoscopy, various endoscopic interventions have been used for the treatment of bleeding duodenal diverticula, including epinephrine injections, hemoclips, bipolar coagulation, and argon plasma coagulation [1][2][3][4][5][6].…”