Blutendes Duodenaldivertikel – eine therapeutische Herausforderung

Zusammenfassung

Anhand einer Kasuistik (81-jährige Patientin) wird die Problematik der endoskopischen Therapie der Spontanblutung aus einem Duodenaldivertikel dargestellt. Im Rahmen der Anwendung eines Hämoclips kam es zu einer Perforation und damit zur Notwendigkeit des operativen Eingreifens. Obwohl das endoskopische Bild auch im Nachhinein die Indikationsstellung korrekt darstellt, scheint es nicht möglich zu sein, aus dem makroskopischen Bild auf die wirklichen Wandverhältnisse im Divertikel schließen zu können. Anhand der Literaturangaben werden die möglichen Therapieverfahren diskutiert und Empfehlungen für die praktische Arbeit gegeben.

Abstract

We report the case of an 81-year-old women with a duodenal diverticular bleeding in the second portion of the duodenum. Various therapies are used to halt haemorrhaging in this tissue, including surgical or endoscopic intervention and transarterial embolisation. The lesion was identified and treated endoscopically with hypertonic saline solution and epinephrine. Because of a fistula and a continual bleeding we use a hemoclip two days later. The bleeding was completely controlled. However, a small mucosal defect was noted at the site where the hemoclip was applied, and an operation was necessary. Finally we discuss the therapy optoins based on a review of the literature.

Schlüsselwörter

Duodenaldivertikel - Blutung - Perforation - Hämoclip

Key words

duodenal diverticulum - bleeding - perforation - hemoclip

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