Ulcer in a Bulbar Diverticulum: An Atypical Localization and Rare Complication of Gastrointestinal Hemorrhage

Gastrointestinal bleeding remains a frequent reason for emergency consultations, with a mortality rate that is still worrying despite advances in treatment. The most common cause is gastro-duodenal ulcers, mainly linked to Helicobacter pylori. Unusual causes such as gastroduodenal diverticular haemorrhage, a rare and serious complication, can also be detected during endoscopy. Although duodenal diverticula are the second most common localization after the colon, gastric intra-diverticular ulcers are extremely rare and rarely described in the literature. Treatment of diverticular haemorrhage can range from medical therapy to diverticulotomy. We present a case of upper gastrointestinal bleeding due to an unusual localization, specifically a gastro-duodenal ulcer situated within a diverticulum of the bulb. This article emphasizes the importance of meticulous exploration of gastric diverticula during gastroscopy, as they may conceal ulcers. Such endoscopic interventions can significantly impact patient management and prognosis, potentially altering outcomes from simple proton pump inhibitor therapy to preventing mortality, which remains alarmingly high according to existing literature.