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A duodenal diverticulum caused severe gastrointestinal bleeding in an elderly patient. Surgical intervention and enteroscopy were crucial for diagnosis and successful hemostasis.

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Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology

Background:

  • Gastrointestinal bleeding is a common and potentially life-threatening condition, particularly in the elderly.
  • Identifying the source of obscure gastrointestinal bleeding can be challenging, requiring advanced diagnostic modalities.

Observation:

  • An 82-year-old patient presented with significant upper gastrointestinal bleeding, initially unresponsive to conservative management.
  • Despite negative upper endoscopy, the patient developed hemodynamic instability, necessitating further investigation.
  • CT angiography and subsequent enteroscopy identified a bleeding duodenal diverticulum near the ligament of Treitz.

Findings:

  • A large duodenal diverticulum (5x4 cm) was identified as the source of active bleeding from a small artery.
  • Surgical management involving ligation of bleeding vessels and diverticulectomy successfully achieved hemostasis.
  • Enteroscopy played a critical role in diagnosing the bleeding source in the duodenum and upper small intestine.

Implications:

  • Enteroscopy is a valuable tool for diagnosing and managing bleeding from duodenal and upper small intestinal pathologies.
  • A multidisciplinary approach is essential for the effective management of complex gastrointestinal bleeding cases.
  • Prompt diagnosis and targeted intervention, such as diverticulectomy, can lead to successful outcomes in patients with obscure gastrointestinal bleeding.