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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, haemorrhage, 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 embolisation (TAE) for a duodenal diverticular haemorrhage. Their study was published on 14 August 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 haemorrhage complicated by duodenal obstruction can happen after transcatheter arterial embolisation by ischaemic damage to the duodenum or fibrotic encasement of the duodenum. Complications of peridiverticular and retroperitoneal fibrosis around the resolving haematoma could happen after successful TAE; therefore, the resolving haematoma should be thoroughly observed. Conservative treatment should be considered before surgery to relieve the duodenal obstruction resulting from duodenal fibrotic encasement after duodenal diverticular haemorrhage. 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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