Abstract
A 43-year-old Japanese woman was admitted to our hospital because of an episode of massive hematemesis and melena. On admission her vital sign was unstable due to hypovolemia by bleeding. Emergency upper gastrointestinal (GI) endoscopy using a f owardviewing endoscope (Olympus Q-200, Olympus Japan Inc.) could not confirm the bleeding point from the esophagus to the second portion of the duodenum. Conservative therapy was done on her but massive melena occurred 2 days later. Total colonoscopy showed no evidence of bleeding in the colon. Angiography and scintigraphy failed also to detect bleeding points. Therefore, upper GI endoscopy was performed again. A mucosal erosion was noted within the diverticulum located in the third portion of the duodenum. Clipping was performed around the erosion because it seemed to be the bleeding point. However, she had again massive melena 4 days after the treatment. Upper GI endoscopy revealed active bleeding from the erosion in the diverticulum. 10 milliliters of Aethoxysklerol was injected into and around the erosion and hemostasis was effectively achieved. Duodenoscopy done 12 days after the injection therapy revealed red scars at the site of erosion. This is the first report of successful hemostasis achieved by Aethoxysklerol injection therapy against a bleeding duodenal diverticulum.
