BACKGROUND Dieulafoy's lesion is a rare vascular abnormality characterized by a small abnormally dilated artery that runs a tortuous course in the submucosa.There is usually no ulcer present in Dieulafoy's les...BACKGROUND Dieulafoy's lesion is a rare vascular abnormality characterized by a small abnormally dilated artery that runs a tortuous course in the submucosa.There is usually no ulcer present in Dieulafoy's lesions and the overlying mucosa is most often normal.Bleeding caused by a Dieulafoy's lesion is usually urgent,massive,life-threatening and prone to recurrence.Dieulafoy's lesions have been reported throughout the digestive tract although the majority of them have been found in the upper digestive tract especially the stomach and duodenum.However,a Dieulafoy's lesion occurring inside a duodenal diverticulum is very rare.CASE SUMMARY A 74-year-old Asian male with epigastric pain,hematemesis and melena was admitted to our clinic.Before admission,the patient had vomited 500 m L of dark red blood,and passed 200 g of black tarry stool.Conservative management was first undertaken as the patient had not been fasting.However,hemorrhage recurred and the patient went into shock.Urgent endoscopy was performed and a diverticulum of 1.8 cm×1.2 cm×0.8 cm was found on the anterior wall of the descending duodenum.The diverticulum was covered with a blood clot.After the clot was removed,an artery stump was observed in the diverticulum with a diameter of 2-3 mm.Two titanium hemostatic clips were inserted to clamp the vessel stump.The patient was discharged 7 d post-endoscopy and followed for 6 mo with no recurrence.CONCLUSION This case was diagnosed with a Dieulafoy's lesion inside a duodenal diverticulum which has rarely been reported.Hematemesis was stopped by clamping the vessel stump with titanium clips.No complications occurred.展开更多
Duodenal diverticula are common and are usually found in patients undergoing roentgenographic investigation of the upper gastrointestinal tract. The majority of these cases are asymptomatic and rarely require operativ...Duodenal diverticula are common and are usually found in patients undergoing roentgenographic investigation of the upper gastrointestinal tract. The majority of these cases are asymptomatic and rarely require operative intervention. Occasionally they can result in the obstruction of the biliary and/or pancreatic ducts, haemorrhage or perforation. Symptomiatic cases may require endoscopic or surgical intervention. Herein, we present a case report of a female patient who underwent surgical procedure due to repetitive obstructive symptoms.展开更多
Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duoden...Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duodenal divericular bezoar are rare. Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar. Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported. Small bowel obstruction by a bezoar is also rare, but it is a complication that requires surgery. This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen, which mimicked pancreatic abscess or microperforation on abdominal computerized tomography. The patient underwent surgical removal of the bezoar and recovered completely.展开更多
文摘BACKGROUND Dieulafoy's lesion is a rare vascular abnormality characterized by a small abnormally dilated artery that runs a tortuous course in the submucosa.There is usually no ulcer present in Dieulafoy's lesions and the overlying mucosa is most often normal.Bleeding caused by a Dieulafoy's lesion is usually urgent,massive,life-threatening and prone to recurrence.Dieulafoy's lesions have been reported throughout the digestive tract although the majority of them have been found in the upper digestive tract especially the stomach and duodenum.However,a Dieulafoy's lesion occurring inside a duodenal diverticulum is very rare.CASE SUMMARY A 74-year-old Asian male with epigastric pain,hematemesis and melena was admitted to our clinic.Before admission,the patient had vomited 500 m L of dark red blood,and passed 200 g of black tarry stool.Conservative management was first undertaken as the patient had not been fasting.However,hemorrhage recurred and the patient went into shock.Urgent endoscopy was performed and a diverticulum of 1.8 cm×1.2 cm×0.8 cm was found on the anterior wall of the descending duodenum.The diverticulum was covered with a blood clot.After the clot was removed,an artery stump was observed in the diverticulum with a diameter of 2-3 mm.Two titanium hemostatic clips were inserted to clamp the vessel stump.The patient was discharged 7 d post-endoscopy and followed for 6 mo with no recurrence.CONCLUSION This case was diagnosed with a Dieulafoy's lesion inside a duodenal diverticulum which has rarely been reported.Hematemesis was stopped by clamping the vessel stump with titanium clips.No complications occurred.
文摘Duodenal diverticula are common and are usually found in patients undergoing roentgenographic investigation of the upper gastrointestinal tract. The majority of these cases are asymptomatic and rarely require operative intervention. Occasionally they can result in the obstruction of the biliary and/or pancreatic ducts, haemorrhage or perforation. Symptomiatic cases may require endoscopic or surgical intervention. Herein, we present a case report of a female patient who underwent surgical procedure due to repetitive obstructive symptoms.
文摘Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duodenal divericular bezoar are rare. Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar. Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported. Small bowel obstruction by a bezoar is also rare, but it is a complication that requires surgery. This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen, which mimicked pancreatic abscess or microperforation on abdominal computerized tomography. The patient underwent surgical removal of the bezoar and recovered completely.
