Abstract
A 77 year-old female having hypertension was admitted to our hospital because of hematemesis and tarry stool. Although she experienced the same bleeding episodes at least 4 times for over the last 7 years, a bleeding source could not be detected. After admission panendoscopic exermination was done repeatedly and finally it revealed an active bleeding from the eroded vessel at the duodenal diverticulum. Since ethanol injection therapy was failed to control the bleeding, ligation of the eroded vessel under laparotomy was performed and no hemorrhage took place thereafter. There are 44 reported cases of hemorrhage from duodenal diverticulum in Japan. Four cases of them had the similar clinical course of ours, i.e. intermittent and repeated hemorrhage more than two times in the past. All these 5 cases were female and had diverticulum at a distal portion of duodenum which was not cheched by routine panendoscopic exerminations. But the diverticula of 4 cases, located at the transverse portion, were eventually detected by repeated panendoscopic exermination for distal part of the duodenum. Therefore, in a case of repeated upper gastrointestinal bleeding from unknown origin, the endoscopic exermination should be performed down to the distal portion of the duodenum to rule out the diverticular hemorrhage.
