Johanns W, Jakobeit C, Greiner L
Medizinische Klinik A, Universität Witten-Herdecke.
Dtsch Med Wochenschr. 1996 Jan 26;121(4):90-3. doi: 10.1055/s-2008-1042977.
A 70-year-old previously healthy woman had been feeling nauseous for one day and had passed several liquid tarry stools. A barium meal previously done as an out-patient had shown a duodenal diverticulum 3.5 cm in diameter with marked contrast-medium retention. Her general condition was impaired, her skin pale and cold, while heart rate and blood pressure were normal. Rectal examination confirmed tarry stool and thus suggested upper gastrointestinal bleeding, the contrast-medium retention pointing to the duodenal diverticulum as a likely site.
Haemoglobin concentration was 9.1 g/dl, the haematocrit 26.6%. Total protein was reduced to 4.4 g/dl. Esophagogastroduodenoscopy (performed about 10 hours after the barium meal) showed erosion at the duodenal bulb and contrast retention in the juxtapapillary diverticulum, but no acute bleeding was discovered.
Repeat endoscopy on the following day revealed acute bleeding (Forrest stage Ia) from an arterial stump in the diverticulum. It was stopped with local injection of adrenaline (6 ml of 1:10,000 solution) and fibrin glue, but the injections had to be repeated twice. Another endoscopy 30 days after the first showed merely a mucosal scar.
Early endoscopy enables one to make the diagnosis and to provide minimally invasive treatment of bleeding from a duodenal diverticulum.
一名70岁、既往健康的女性，恶心1天，排过几次柏油样稀便。此前门诊行钡餐检查显示直径3.5 cm的十二指肠憩室，有明显造影剂潴留。她的一般状况较差，皮肤苍白且冰冷，心率和血压正常。直肠指检证实为柏油样便，提示上消化道出血，造影剂潴留表明十二指肠憩室可能是出血部位。
血红蛋白浓度为9.1 g/dl，血细胞比容为26.6%。总蛋白降至4.4 g/dl。食管胃十二指肠镜检查（在钡餐检查后约10小时进行）显示十二指肠球部糜烂，乳头旁憩室有造影剂潴留，但未发现急性出血。
次日重复内镜检查发现憩室内动脉残端急性出血（福里斯特Ia期）。通过局部注射肾上腺素（6 ml 1:10,000溶液）和纤维蛋白胶止血，但注射不得不重复两次。首次检查30天后再次内镜检查仅见黏膜瘢痕。
早期内镜检查能够诊断十二指肠憩室出血并提供微创治疗。
