A Case of Bleeding from the Distal Duodenal Diverticulum diagnosed by Multidetector Computed Tomography

We report a case of bleeding from a diverticulum in the fourth portion of the duodenum detected by multidetector computed tomography (MDCT). A 78-year-old woman undergoing hemodialysis for chronic renal failure twice a week produced coffee-ground-like vomitus during dialysis and her blood pressure dropped, necessitating emergency upper gastrointestinal endoscopy. We found no bleeding source in the esophagus, stomach, or first and second portions of the duodenum, but fresh blood regurgitated from the anal end. In 64-row MDCT, a slightly hypodense 40 mm mass was found in the fourth portion of the duodenum with adjacent extravasation. The patient's vital signs had not been stabilized despite a blood transfusion, so we conducted emergency laparotomy to resect a diverticulum with hematoma and closed the excision site by suture. Diverticulectomy and primary closure is minimally invasive and optimal in the surgical management of duodenal diverticular bleeding, and contrast-enhanced MDCT is useful in diagnosing suspected acute gastrointestinal bleeding.