Case Report

Pneumoretroperitoneum and Pneumoperitoneum Following Argon Plasma Coagulation for a Bleeding Duodenal Diverticulum: A Case Report

Authors: Pei-Yuan Su, MD, Hsu-Heng Yen, MD

Abstract

Duodenal diverticula are usually asymptomatic, with an incidence of 0.16% to 22%. Symptomatic bleeding from a duodenal diverticulum is an even rarer event. The management of such a hemorrhage is almost entirely surgically based. Since the first reported case of endoscopic therapy for duodenal diverticular bleeding (DDB) by Sim et al, only two case series have been reported in the literature regarding endoscopic therapy for DDB. Hence, the optimal therapy modality for DDB remains unclear. A rare case involving massive pneumoretroperitoneum and pneumoperitoneum following argon plasma coagulation treatment for DDB is presented. A short discussion of the optimal endoscopic therapy for this rare disease is provided.


Key Points


* Duodenal diverticular bleeding is a rare cause of upper GI bleeding.


* Endoscopic management allows a nonoperative treatment option, but the optimal endoscopic treatment method remains unclear due to limited experience.


* From our experience, we suggest clipping may be the preferred initial endoscopic treatment modality compared with other thermal therapy.

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