• Vol. 34 No. 10, 636–638
  • 15 November 2005

Periampullary Diverticulum: A Case of Bleeding from a Periampullary Diverticula



Introduction: Duodenal diverticula are uncommon and usually asymptomatic. Complications like bleeding, perforation and biliary fistulae are rare. The management of a bleeding duodenal diverticulum can be challenging. With the improvement of endoscopic techniques, many of the cases reported in the literature were managed with endoscopic methods. We present a case report of bleeding duodenal diverticulum. Clinical Features: The patient was treated successfully with endoscopic haemostasis during her first epidsode when she initially presented with bleeding duodenal diverticulum, but recurred after 2 months. Treatment: Despite initial endoscopic haemostasis during her second episode, she rebled after 2 days, necessitating surgical management. Outcome: After suture ligation of the ulcer, the patient recovered and there was no more recurrence. Conclusion: Periampullary diverticulum is a rare source of gastrointestinal bleeding, which can be challenging to diagnose and treat. A multidisciplinary approach encompassing radiology, endoscopy and surgery is most effective.

Duodenal diverticula were reported for the first time by Chomel in 1710. 1 They can be classified as either congenital or acquired and intraluminal or extraluminal. They typically occur in the periampullary region, along the medial aspect of the second and third part of the duodenum. Periampullary diverticula (PAD) are extraluminal outpouchings of the duodenum arising within a radius of 2 to 3 cm from the ampulla of Vater. The true prevalence in the general population is difficult to ascertain, with reported rates varying between 0.16% and 27%, according to the diagnostic tests. For upper gastrointestinal radiological contrast studies, incidence rates range from 2% to 5%, whereas for endoscopic retrograde cholangiopancreatography (ERCP) and autopsies, incidence rates have been reported at about 22%.2 As most of these patients are asymptomatic, these incidence rates may not be reflective of the true prevalence.

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