Diagnostic Usefulness of Scintigram for Gastrointestinal Bleeding in a Case of Massive Hemorrhage from Duodenal Diverticulum

Naoki Imai, Masahiro Sekino, Yukio Shimizu, Ryuji Hosono, Masahiro Goto, Hiroshi Tanabe, Jun Fujii*

Department of Surgery, *Department of Internal Medicine, General Yoro Central Hospital

A woman, aged 48 years, was seen at our hospital with the chief complaints of hematemesis and blood bowel discharge. Laboratory tests showed RBC of 246×10⁴/mm³, Hb of 7.3 g/dl and Ht of 22.1%, indicating anemia. Gastrointestinal endoscopy did not reveal any source of hemorrhage between the esophagus and duodenal papillae. Scintigram for gastrointestinal hemorrhage showed accumulation of activity on the medial side of the right kidney. Although angiography was planned, the patient developed shock and underwent an emergency operation. Upon laparotomy a tense diverticulum approximately, 4 cm in diameter with thrill was noted on the wall of the duodenal convolution. Resection of this diverticulum led to elevation of the patient's blood pressure. This was a case of true diverticulum, at the bottom of which was a shallow ulcer surrounded by slight protuberance and a thin blood vessel. It was judged that the blood vessel was the source of hemorrhage. In very rare cases, massive hemorrhage from duodenal diverticulum occurs. No more than 21 patients have been reported in Japan, including 11 in which the diverticulum alone was resected and 7 who underwent diverticulum resection plus gastrectomy. In none of the 11 with the diverticulum resection alone did hemorrhage occur. It was thought that gastrectomy should not be performed for this disease, which is likely to result in shock, requiring emergency surgery.

Key words
massive hemorrhage from duodenal diverticulm, diagnostic usefulness of scintigram for gastrointestinal bleeding, excision of duodenal diverticulm without gastrectomy

Reprint requests
Naoki Imai Department of Surgery, General Yoro Central Hospital
986 Oshikoshi, Yoro-cho, Yoro-gun, Gifu, 503-13 JAPAN

Accepted
January 13, 1993

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