A Case Report of Massive Hemorrhage from Parapapillary Diverticulum Treated by Transcatheter Arterial Embolization

Masaaki Mitsutsuji, Takao Ichihara, Tomoaki Urakawa

Department of surgery, Kobe Rosai Hospital of the Labor Welfre Corporation

We report a case of massive hemorrhage from parapapillary diverticulum treated by TAE. An 82-year-old man was seen at our hospital with the chief complaints of hematemesis and blood bowel discharge. Laboratory tests showed RBC of 269×10⁴/mm³, Hb of 8.7 g/ml and Ht of 24.5%, indicating anemia. Urgent gastrointestinal endoscopy did not reveal any source of hemorrhage. Abdominal US and CT showed a cyst at the body of the pancreas. At ERCP, parapapillary diverticulum was seen and it was covered with fresh blood. The pancreatic duct was not dilatated and there was no relation between the cyst and the pancreatic duct. Scintigram for gastrointestinal hemorrhage and abdominal angiography showed no bleeding focus. At the second endoscopic examination, the diverticulum was covered with fresh blood as before, so we diagnosed the hemorrhage from the diverticulum. TAE was performed for ASPD, PSPD and AIPD with gelfoam and microcoil. After this, the patient developed the complication of acute slight pancreatitis, but it remitted with conservative treatment. Re-bleeding was not seen. When vital signs are stable, TAE is valuable for stopping hemorrhage which is hard to control.

Key words
parapapillary diverticulum, gastrointestinal hemorrhage, TAE

Reprint requests
Masaaki Mitsutsuji Department of Surgery, Kobe Rosai Hospital of the Labor Welfare Corporation
4-1-23 Kagoike-dori, Chuou-ku, Kabe, 651 JAPAN

Accepted
March 8, 1995

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