1993 Volume 43 Pages 188-191
A 65-year-old man was admitted to our hospital for vitrectomy due to the diabetic retinopathy although he has stated to be hemodialyzed under diagnosis of diabetic renal failure for 1 year. After the surgery, vancomycin had administrated because fever and diarrhea were appeared and was diagnosed pseudomembranous colitis by colonoscopy. After while myocardial infarction and cardiac failure were detected, and intravenous heparin administration was added.
A few days later massive tarry stool was noted and hemoglobin falled to 4.8 g/dl. The 4 ulcers were revealed in the descending part of duodenum by endoscopy, the two on the anterior and posterior wall close the bulb and the one beside the major papilla and remaining large one below the major papilla over the inferior duodenal angulus. But the active bleeding source was unknown throughout GI tract. The anemia was improved only after large amount of blood transfusion. Finally, repeated endoscopy found the enlarged ulcer with continous bleeding area close to the major papilla to the inferior duodenal angulus and various hemostatic procedures were undergone duodenoscopically.
In cases with serious background, ulcer located in the second part of duodenum induced severe hemorrhage, probably due to unusual micro circulation and poor protecting disorder. Side viewing instrument was quite effective to stop the bleeding using various procedures.
