title: [Duodenal diverticulum in the third portion of duodenum as a cause of upper gastrointestinal bleeding and chronic abdominal pain. Case report and literature review].
abstract: BACKGROUND
  Duodenal diverticulum is a little-known pathology. The duodenum represents second place in frequency for the presence of diverticula in the digestive tract after the colon. Duodenal diverticulum as a cause of hemorrhage of the upper gastrointestinal (GI) tract has been described as an infrequent complication, although it must be considered in patients with digestive hemorrhage without evident cause at the esophagogastric level. Localization of diverticula in the third or fourth portions of the duodenum is rare and the diverticula are asymptomatic in 90% of cases. Diagnosis is made by endoscopy, contrast X-rays of the upper GI tract, selective arteriography and as a transoperative finding. The objective of this study was to identify and analyze the clinical presentation of duodenal diverticulum to familiarize surgeons and gastroenterologists when there is suspicion of the diagnosis.
  
  
  METHODS
  We report the case of an 85-year-old female presenting with massive upper GI tract hemorrhage and chronic abdominal pain due to a duodenal diverticulum located in the third portion of the duodenum. Diagnosis was made with upper GI barium series because visualization of the diverticulum was not possible by endoscopy. Other therapeutic options are described in the literature. A successful simple diverticulectomy, manually opened with a two-plane transversal incision, was performed on the patient. After >12 months of follow-up, the patient is completely asymptomatic.
  
  
  CONCLUSIONS
  Clinical diagnosis presents difficulty because a classic presentation does not exist. Symptoms are generally vague, <10% of the duodenal diverticulum are frankly symptomatic, and <1 to 2% will require surgical resolution.
  
  
  CONCLUSIONS
  Hemorrhage of the upper GI tract and chronic abdominal pain secondary to duodenal diverticulum present with recurrence and may be associated with the presence of duodenal diverticulum when other sources of bleeding are not found.
authors.affiliation: Departamento de Cirugía General, Hospital General Zona, MF No 1, Instituto Mexicano del Seguro Social, Colima, Mexico. surgeonjsjf@yahoo.com
authors.forename: Jorge
authors.initials: J
authors.lastname: Avalos-González
authors.forename: Alejandro
authors.initials: A
authors.lastname: Zaizar-Magaña
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D001466:Barium Sulfate; D001803:Blood Transfusion; D002908:Chronic Disease; D003287:Contrast Media; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003951:Diagnostic Errors; D004240:Diverticulum / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D004378:Duodenal Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D004381:Duodenal Ulcer / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal; D005188:False Negative Reactions; D005260:Female; D005440:Fluid Therapy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D011859:Radiography; D012907:Smoking / Q000009:adverse effects
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D003287:Contrast Media; D001466:Barium Sulfate