A Case of Refractory Periampullary Duodenal Diverticulum Hemorrhage Who Was Treated by Duodenal Diverticulectomy

Abstract

A man in his 60s was admitted to our hospital with melena and abdominal pain. On the day after admission, he went into hemorrhagic shock due to gastrointestinal bleeding. Contrast-enhanced abdominal CT scan revealed extravasation from the periampullary duodenal diverticulum, and angiography confirmed bleeding from the anterior superior pancreaticoduodenal artery. Temporary hemostasis was achieved with coil embolization; however, rebleeding occurred on the day 7 of hospitalization. Repeat endovascular treatment failed to control the hemorrhage. Therefore, we performed an emergent duodenal diverticulectomy, which resulted in successful hemostasis. Surgical intervention remains a valuable option for periampullary duodenal diverticulum hemorrhage when bleeding cannot be controlled by endoscopic or endovascular treatment. Duodenal diverticulectomy may be considered as a surgical option in cases where an adequate distance can be secured between the papilla of Vater and the diverticulum.