Korean J Gastroenterol.  2016 Mar;67(3):146-149. 10.4166/kjg.2016.67.3.146.

Successful Management of Periampullary Diverticular Bleeding with Hemoclipping Using Side-viewing Endoscope during Endoscopic Retrograde Cholangiopancreatography

• Park BG
• Yoo YW
• Song JC
• Gam SH
• Kim MS
• Ko BS

• KMID: 2373415
• DOI: http://doi.org/10.4166/kjg.2016.67.3.146

Abstract

Periampullary diverticulum is commonly found during endoscopy and can occur at any age although its prevalence increases with age. Periampullary diverticular bleeding is a rare and difficult to diagnose during clinical practice because of its unique appearance and location. This often can lead to massive bleeding and interfere with adequate bleeding control. Endoscopic management on duodenal diverticular bleeding is limited compared to colonic diverticular bleeding due to lack of experience. Herein, we report a case of active bleeding from a periampullary diverticulum during bile duct stone extraction diagnosed by side-viewing endoscope and successfully controlled using hemoclips without any complications.

Keyword

Bleeding; Periampullary diverticulum; Hemoclip; Duodenoscope

MeSH Terms

Aged
Ampulla of Vater/surgery
Cholangiopancreatography, Endoscopic Retrograde
Diverticulum/*diagnosis/surgery
Gastrointestinal Hemorrhage/etiology/*therapy
Humans
Male
Surgical Instruments
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Abdominal computed tomography reveals gall bladder stones (A) and proximal extrahepatic bile duct dilatation with distal common bile duct stones (B). The diameter of the distal common bile duct measures about 1 cm.

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  Fig. 2. Initial duodenoscopic examination reveals a large clot and fresh blood within the periampullary diverticulum on the second portion of duodenum.

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  Fig. 3. After removal of bile duct stone, spurting of blood, presumably a Dieulafoy-like lesion, was noted at the base of periampullary diverticulum.

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  Fig. 4. Two hemoclips were successfully placed at bleeding site within the periampullary diverticulum using the side-viewing endoscope and hemostasis was achieved instantly.

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  Fig. 5. Follow-up endoscopy after hemostasis showed that hemoclips were placed securely at the lesion and recurrent bleeding was not observed.

Reference

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