Digestive Medicine, Hospital General Universitario de Elche, España .
Digestive Medicine, Hospital General Universitario de Elche, España.
Rev Esp Enferm Dig. 2022 Mar;114(3):179. doi: 10.17235/reed.2021.8373/2021.
An 80-year-old female with a mechanic mitral valve treated with acenocumarol was admitted to the hospital due to tarry stools over the last two days and hemoglobin levels of 5.6 g/dl. She had not biliary pathology. An emergency esophagogastroduodenoscopy showed lots of fresh clots over the second part of the duodenum that seemed to come from the major papilla. A duodenoscopy was performed in order to obtain a direct view, showing a huge clot near the papilla. Its removal with a polypectomy snare revealed a large duodenum diverticulum with little saculations inside, one of which showed a visible, actively bleeding vessel. Sclerosis with epinephrine was performed and subsequently, two through-the-scope Cook® 11 mm clips were placed, achieving the cessation of the hemorrhage. Several attempts with different clips were needed since they were separated by the elevator nail of the duodenoscope. No complications developed during the procedure or once anticoagulation was restarted.
一位 80 岁女性，因机械性二尖瓣病变接受 acenocoumarol 治疗，因两天来黑便和血红蛋白水平为 5.6 g/dl 而住院。她没有胆道疾病。紧急食管胃十二指肠镜检查显示十二指肠第二段有大量新鲜血栓，似乎来自主乳头。进行十二指肠镜检查以获得直接观察，显示乳头附近有一个巨大的血栓。用息肉切除术圈套器取出血栓后，发现一个大的十二指肠憩室，内部有小的囊泡，其中一个可见明显的、正在出血的血管。用肾上腺素进行硬化治疗，随后放置了两个通过内镜的 Cook® 11mm 夹，实现了出血的停止。由于十二指肠镜的提升钉的分隔，需要多次尝试不同的夹子。在操作过程中或重新开始抗凝治疗后，均未发生任何并发症。
