Duodenal diverticulum in the third portion of duodenum as a cause of upper gastrointestinal bleeding and chronic abdominal pain. Case report and literature

Jorge Ávalos-González; Alejandro Zaizar-Magaña

2008, Number 1

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Cir Cir 2008; 76 (1)

Duodenal diverticulum in the third portion of duodenum as a cause of upper gastrointestinal bleeding and chronic abdominal pain. Case report and literature

Ávalos-González J, Zaizar-Magaña A

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Language: Spanish
References: 28
Page: 65-69
PDF size: 122.00 Kb.

ABSTRACT

Background: Duodenal diverticulum as a cause of hemorrhage of the upper gastrointestinal tract has been described as an infrequent complication, although it must be considered in patients with digestive hemorrhage without evident cause at the esophagus/gastric level. Localization of diverticula in the third or fourth portions of the duodenum is rare and the diverticula are asymptomatic in 90 % of cases. Diagnosis is made by endoscopy, contrast X-rays of the upper gastrointestinal tract, selective arteriography and as a transoperative finding. The objective of this study was to identify and analyze the clinical presentation of duodenal diverticulum to familiarize surgeons and gastroenterologists when there is suspicion of the diagnosis.
Clinical case: We report the case of an 85-year-old male presenting with massive upper digestive tract hemorrhage and chronic abdominal pain due to a duodenal diverticulum located in the third portion of the duodenum. Diagnosis was made with barium esophagus/gastroduodenal series. Other therapeutic options are described in the literature. A successful simple diverticulectomy, manually opened with a two-plane transversal incision, was performed on the patient. After ›12 months of follow-up, the patient is completely asymptomatic.
Discussion: Clinical diagnosis presents difficulty because a classic presentation does not exist. Symptoms are generally vague, ‹, 10 % of the duodenal diverticulum are frankly symptomatic, and ‹ 1 to 2 % will require surgical resolution.
Conclusions: Hemorrhage of the upper gastrointestinal tract and chronic abdominal pain secondary to duodenal diverticulum present with recurrence and may be associated with the presence of duodenal diverticulum when other sources of bleeding are not found.

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