Duodenal obstruction after successful embolization for duodenal diverticular hemorrhage: A case report

Figure 1 Computed tomography (CT) image two years before the admission shows an approximately 6 cm sized silent diverticulum (arrows) originating from the proximal third portion of the duodenum (curved arrow).

Figure 2 Diagnostic images on admission. A: An approximately 7 cm sized acute duodenal diverticular hemorrhage (curved arrow) and surrounding large retroperitoneal hematoma (arrows) around the duodenum on contrast enhanced CT image; B: The causative arterial pseudoaneurysm (arrow) on superior mesenteric arteriogram; C: Barium leakage into the large hemorrhagic duodenal diverticulum (arrows) and another small silent diverticulum (curved arrow) in the duodenal third portion on upper gastrointestinal barium study.

Figure 3 CT images when the patient complained of gastrointestinal obstruction 2 wk after admission. A: Previously noted large duodenal diverticular hemorrhage and retroperitoneal hematoma were decreased in size (arrowheads); B: However, marked edematous bowel wall thickening is newly visualized in the duodenal second and third portions (arrows).

Figure 4 Intra-operative findings. A: A hard duodenal diverticulum filled with old hematoma, which was covering about 10 cm of the duodenal second portion, with severe peridiverticular fibrosis (arrows); B: The diverticular opening at the 3rd portion of the duodenum (arrow).