title: Active bleeding from a periampullary duodenal diverticulum that was difficult to diagnose but successfully treated using hemostatic forceps: a case report.
abstract: BACKGROUND
  Although duodenal diverticula are common, periampullary duodenal diverticula are rare. Periampullary duodenal diverticula are usually asymptomatic and may be difficult to diagnose and treat. However, they may present with massive bleeding, requiring prompt diagnosis.
  
  
  METHODS
  We report the case of a 71-year-old Asian woman with bleeding from a periampullary duodenal diverticulum. She presented with severe anemia and tarry stools. Two examinations using a forward-viewing endoscope did not identify the source of the bleeding. However, examination using a side-viewing endoscope found an exposed bleeding vessel overlying the bile duct within a periampullary diverticulum of the descending part of the duodenum. The bleeding was successfully controlled by using hemostatic forceps.
  
  
  CONCLUSIONS
  Bleeding periampullary duodenal diverticula are rare, and a bleeding point in the mucosa overlying the bile duct within a large periampullary duodenal diverticulum is very rare. Identification of a bleeding point within a duodenal diverticulum often requires repeated examination and may require the use of a side-viewing endoscope. Use of hemostatic forceps to control bleeding from a periampullary duodenal diverticulum is very rare but, for bleeding lesions overlying the bile duct within a periampullary duodenal diverticulum, is the best way to prevent obstructive jaundice.
authors.affiliation: Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Miki, Kagawa, Kita, 761-0793, Japan. n-nori@med.kagawa-u.ac.jp.
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishiyama
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.forename: Kazi
authors.initials: K
authors.lastname: Rafiq
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.forename: Shintarou
authors.initials: S
authors.lastname: Fujihara
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki