Fujii K, Fujioka S, Kato K, Machiki Y, Kutsuna Y, Ishikawa A, Takamizawa J, Mizutani T, Ko K, Nimura Y
Department of Surgery, Kiryu Kousei General Hospital, Kiryu, Japan.
Hepatogastroenterology. 2001 Jul-Aug;48(40):1058-60.
A 70-year-old woman presented with a 2-day history of tarry stool. She had a history of hemorrhage from a duodenal diverticulum of the 2nd portion 8 years previously that had been managed successfully by endoscopic hemostasis. Initial gastrointestinal endoscopy revealed ulceration of the diverticulum with no active bleeding; nevertheless the ulceration was presumed to be the source of the tarry stool. Despite medical treatment, bleeding started again, but endoscopic ethanol injection achieved hemostasis. When bleeding started yet again 8 days after the endoscopic therapy, the patient underwent diverticulectomy. Although duodenal diverticula are frequently found in the adult gastrointestinal tract, they rarely show hemorrhage. Recently, there has been controversy about whether bleeding diverticula should be managed surgically or endoscopically. We describe for the first time a rare case of recurrent hemorrhage of a duodenal diverticulum after an 8-year interval; the case was treated by surgical diverticulectomy as a definitive therapy for the recurrent bleeding ulcer. We also present a review of the literature.
一名70岁女性出现柏油样便2天。她8年前曾有十二指肠降部憩室出血病史，当时经内镜止血成功治疗。初次胃肠内镜检查发现憩室溃疡，无活动性出血；尽管如此，溃疡仍被认为是柏油样便的来源。尽管进行了药物治疗，出血再次发生，但内镜下乙醇注射实现了止血。在内镜治疗8天后出血再次发生时，患者接受了憩室切除术。虽然十二指肠憩室在成人胃肠道中很常见，但很少出现出血。最近，关于出血性憩室应采用手术还是内镜治疗存在争议。我们首次描述了一例罕见的十二指肠憩室间隔8年后复发性出血病例；该病例通过手术憩室切除术作为复发性出血溃疡的确定性治疗方法。我们还对文献进行了综述。
