Surgical treatment a rare complication of duodenal diverticulum

Most of the duodenal diverticula are diagnosed incidentally and asymptomatic, 12% to 27 % at endoscopy. Only 5% to 10% of patients with duodenal diverticula suffer from clinical symptoms. Furthermore, less than 1% of patients require treatment for various complications such as perforation, hemorrhage, and biliary/pancreatic/gastrointestinal obstruction. Various treatments and operations are considered for the rare complications of diverticulum, based on the symptoms or operative field findings.

Ho Jeong and his colleague from Korea presented a case of duodenal obstruction after successful selective transcatheter arterial embolization (TAE) for a duodenal diverticular hemorrhage. Their study will be published on August 14, 2009 in the World Journal of Gastroenterology.

In general, angiography and endoscopy are the most useful modalities for diagnosing and managing gastrointestinal bleeding.

However, duodenal diverticular hemorrhage complicated by duodenal obstruction can happen after transcatheter arterial embolization by ischemic damage to the duodenum or fibrotic encasement of the duodenum. Complications of peridiverticular and retroperitoneal fibrosis around the resolving hematoma could happen after successful TAE; therefore, the resolving hematoma should be thoroughly observed. Conservative treatment should be considered before surgery to relieve the duodenal obstruction resulting from duodenal fibrotic encasement after duodenal diverticular hemorrhage. However, if surgery is necessary, gastrointestinal diversion should be done instead of complete resection in cases with severe inflammation or tissue friability.

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Reference: Kwon YJ, Kim JH, Kim SH, Kim BS, Kim HU, Choi EK, Jeong IH. Duodenal obstruction after successful embolization for duodenal diverticular hemorrhage: A case report. World J Gastroenterol 2009 August;15(30):3819-3822

Correspondence to- In Ho Jeong, MD, Department of Surgery, Jeju national University School of Medicine, 1753-3, Ara 1-Dong, Jeju 690-121, South Korea. 41056@naver.com

About World Journal of Gastroenterology

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.