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Perforated Duodenal Diverticulum With Postoperative Diverticulum Bleeding Successfully Treated Using Transcatheter
Hidenori Tomida1, Kan Nakagawa2, Hideyasu Matsumura2
1Surgery, Shinshu University School of Medicine, Matsumoto, JPN.
Cureus
|November 1, 2021
Summary
Perforated duodenal diverticula (DDP) are rare, with challenging diagnosis and treatment. This case highlights postoperative bleeding from a remnant duodenal diverticulum (DD) successfully managed with transcatheter arterial embolization (TAE).
Area of Science:
- Gastroenterology
- Surgical Innovation
- Interventional Radiology
Background:
- Duodenal diverticula (DD) are common incidental findings, but perforation (DDP) is a rare, high-mortality complication with unclear optimal treatment.
- Traditional management for DDP involves surgical repair, though conservative approaches like bowel rest and endoscopic drainage are emerging.
- Duodenal diverticulum bleeding (DDB) is an uncommon cause of upper gastrointestinal bleeding, lacking consensus on the best hemostatic strategy.
Observation:
- A case report detailing a perforated duodenal diverticulum (DD) in an elderly female presenting with abdominal pain and retroperitoneal free air.
- Emergency surgery revealed a perforated DD in the third duodenum; due to severe inflammation, a primary diverticulectomy was avoided, opting for direct orifice suturing with an omental patch.
- The patient experienced postoperative duodenal leakage and subsequent bleeding from the remnant DD on postoperative days 6 and 13, refractory to endoscopic hemostasis.
Findings:
- Transcatheter arterial embolization (TAE) proved effective in achieving hemostasis for the postoperative duodenal diverticulum bleeding (DDB).
- This case represents the first reported instance of duodenal diverticulum perforation complicated by postoperative bleeding from the remnant diverticulum.
- The study suggests that unresectable duodenal diverticula require careful management to prevent leakage and that TAE is a viable option for managing postoperative DDB.
Implications:
- Management of unresectable duodenal diverticula necessitates precautions against duodenal leakage.
- Transcatheter arterial embolization (TAE) is a crucial, effective intervention for managing postoperative duodenal diverticulum bleeding (DDB).
- Further research into optimal surgical and conservative strategies for perforated duodenal diverticula and associated bleeding is warranted.
Keywords:
duodenal diverticulumduodenal diverticulum bleedingduodenal diverticulum perforationendoscopic hemostasistranscatheter arterial embolizationMore Related Videos
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