title: Periampullary diverticulum: a case of bleeding from a periampullary diverticulum.
abstract: BACKGROUND
  Duodenal diverticula are uncommon and usually asymptomatic. Complications like bleeding, perforation and biliary fistulae are rare. The management of a bleeding duodenal diverticulum can be challenging. With the improvement of endoscopic techniques, many of the cases reported in the literature were managed with endoscopic methods. We present a case report of bleeding duodenal diverticulum.
  
  
  METHODS
  The patient was treated successfully with endoscopic haemostasis during her first epidsode when she initially presented with bleeding duodenal diverticulum, but recurred after 2 months.
  
  
  METHODS
  Despite initial endoscopic haemostasis during her second episode, she rebled after 2 days, necessitating surgical management.
  
  
  RESULTS
  After suture ligation of the ulcer, the patient recovered and there was no more recurrence.
  
  
  CONCLUSIONS
  Periampullary diverticulum is a rare source of gastrointestinal bleeding, which can be challenging to diagnose and treat. A multidisciplinary approach encompassing radiology, endoscopy and surgery is most effective.
authors.affiliation: Department of Surgery, National University Hospital, Singapore.
authors.forename: J E H
authors.initials: JE
authors.lastname: Kua
authors.forename: A
authors.initials: A
authors.lastname: Seah
authors.forename: J B Y
authors.initials: JB
authors.lastname: So
mesh_terms: D000368:Aged; D014670:Ampulla of Vater; D003937:Diagnosis, Differential; D004240:Diverticulum / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D004378:Duodenal Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016558:Hemostasis, Endoscopic / Q000379:methods; D006801:Humans