Successful Management of Periampullary Diverticular Bleeding with Hemoclipping Using Side-viewing Endoscope during Endoscopic Retrograde Cholangiopancreatography

Bo Geun Park; Young Wook Yoo; Joon Cheol Song; Sung Hee Gam; Mi Sung Kim; Byeong Seong Ko

doi:10.4166/kjg.2016.67.3.146

Journal List > Korean J Gastroenterol > v.67(3) > 1007485

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Park, Yoo, Song, Gam, Kim, and Ko: Successful Management of Periampullary Diverticular Bleeding with Hemoclipping Using Side-viewing Endoscope during Endoscopic Retrograde Cholangiopancreatography

Case Report

Korean J Gastroenterol 2016;67(3):146-149.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.67.3.146

Successful Management of Periampullary Diverticular Bleeding with Hemoclipping Using Side-viewing Endoscope during Endoscopic Retrograde Cholangiopancreatography

Bo Geun Park, Young Wook Yoo¹, Joon Cheol Song, Sung Hee Gam, Mi Sung Kim¹, Byeong Seong Ko¹

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

¹Gastroenterology & Hepatobiliary Center and Department of Internal Medicine, Cheongju St. Mary's Hospital, Cheongju, Korea

Correspondence to: Young Wook Yoo, Gastroenterology & Hepatobiliary Center and Department of Internal Medicine, Cheongju St. Mary's Hospital, 173-19, Juseong- ro, Cheongwon-gu, Cheongju 28323, Korea. Tel: +82-43-219-8590, Fax: +82-43-219-8744, E-mail: youngwook.ccmc@gmail.com

Received 8 October 2015 Revised 2 November 2015 Accepted 5 November 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Periampullary diverticulum is commonly found during endoscopy and can occur at any age although its prevalence increases with age. Periampullary diverticular bleeding is a rare and difficult to diagnose during clinical practice because of its unique appearance and location. This often can lead to massive bleeding and interfere with adequate bleeding control. Endoscopic management on duodenal diverticular bleeding is limited compared to colonic diverticular bleeding due to lack of experience. Herein, we report a case of active bleeding from a periampullary diverticulum during bile duct stone extraction diagnosed by side-viewing endoscope and successfully controlled using hemoclips without any complications.

Keywords: Bleeding, Periampullary diverticulum, Hemoclip, Duodenoscope

References

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Fig. 1.

Abdominal computed tomography reveals gall bladder stones (A) and proximal extrahepatic bile duct dilatation with distal common bile duct stones (B). The diameter of the distal common bile duct measures about 1 cm.

Fig. 2.

Initial duodenoscopic examination reveals a large clot and fresh blood within the periampullary diverticulum on the second portion of duodenum.

Fig. 3.

After removal of bile duct stone, spurting of blood, presumably a Dieulafoy-like lesion, was noted at the base of periampullary diverticulum.

Fig. 4.

Two hemoclips were successfully placed at bleeding site within the periampullary diverticulum using the side-viewing endoscope and hemostasis was achieved instantly.

Fig. 5.

Follow-up endoscopy after hemostasis showed that hemoclips were placed securely at the lesion and recurrent bleeding was not observed.

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