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Multiple duodenal diverticula as a rare cause of gastroduodenal bleeding
Diverticulosis duodenal múltiple como causa infrecuente de sangrado gastroduodenal
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"documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Gastroenterol Hepatol. 2022;45:209-10" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "Pyriform sinus perforation as a rare complication of endoscopic retrograde cholangiopancreatography" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "209" "paginaFinal" => "210" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La perforación del seno piriforme como una rara complicación de la colangiopancreatografía retrógrada endoscópica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1453 "Ancho" => 1500 "Tamanyo" => 149375 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-ray demonstrating exuberant thoraco-abdominal and neck emphysema. 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She reported having taken two isolated tablets of metamizole due to knee pain. History of interest included hypertension, atrial fibrillation in anticoagulation therapy with acenocoumarol, and postoperative pulmonary thromboembolism in 2007. Laboratory tests showed haemoglobin of 7.6 g/dl, urea of 162 mg/dl and INR in range. In the emergency gastroscopy, duodenal deformity was observed by reason of multiple large diverticular openings (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>), with blood remnants and without stigmata of active bleeding seen. During hospitalisation, she received transfusion support, intravenous iron, and anticoagulation management and she was discharged with good evolution.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Diverticula are saccular herniations of the mucosa and submucosa through the muscular layer of the intestine. The duodenum is the second most common location, after the colon. They are generally asymptomatic and represent an incidental diagnosis, but in up to 5% of cases can cause symptoms such as gastrointestinal bleeding, obstruction or perforation. The treatment of choice is medical and endoscopic, reserving surgery in case this fails.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0015" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">There are no conflicts of interest.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Recommended references</span><p id="par0025" class="elsevierStylePara elsevierViewall">Haßelmann J., Dornbusch J. A rare cause of a chronic bleeding in the upper gastrointestinal tract [artículo en alemán]. Chirurg. 2013;84:322-324.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Oukachbi N., Brouzes S., Management of complicated duodenal diverticula. J Visc Surg. 2013;150:173-179.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Relea Pérez L., Magaz Martínez M., Pons Renedo F. Massive upper gastrointestinal bleeding due to a Dieulafoy's lesion inside a duodenal diverticulum. Rev Esp Enferm Dig. 2017;109:876-877.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Recommended references" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez Delgado S, Mínguez Sabater A, Ladrón Abia P, Alonso Lázaro N. Diverticulosis duodenal múltiple como causa infrecuente de sangrado gastroduodenal. Gastroenterol Hepatol. 2022;45:211–212.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 989 "Ancho" => 905 "Tamanyo" => 122626 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Duodenal bulb deformed by reason of multiple diverticula with remnants of recent bleeding, but without active bleeding (yellow arrows).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 961 "Ancho" => 905 "Tamanyo" => 103252 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiple diverticula.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 903 "Ancho" => 905 "Tamanyo" => 95286 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Multiple diverticula.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004500000003/v1_202204220605/S2444382422000517/v1_202204220605/en/main.assets" "Apartado" => array:4 [ "identificador" => "75461" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004500000003/v1_202204220605/S2444382422000517/v1_202204220605/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382422000517?idApp=UINPBA00004N" ]
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