3- rescue therapy of a duodenal diverticular rebleeding

3- Use of cyanoacrylate glue as a rescue therapy of a duodenal diverticular rebleeding

Title: Use of cyanoacrylate glue as a rescue therapy of a duodenal diverticular rebleeding

Authors:Roberto Grassia 1, Teresa Staiano, Elena Iiritano, Guglielmo Bianchi, Paolo Dizioli, Giovanni Paolo Coppeta, Federico Buffoli Digestive Endoscopy and Gastroenterology Unit, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy.

PMID: 21821249 DOI: 10.1016/j.gie.2011.05.048

Abstract: An 81-year-old man was admitted to the hospital because of recurrent hematochezia and hemorrhagic shock.
He had a history of alcohol-related cirrhosis and hypertension. Laboratory findings revealed severe anemia.
An urgent upper endoscopy showed a giant diverticulum (diameter of about 4 cm) filled with a blood clot in the third duodenal portion. After irrigation, a pulsatile bleeding
site on the diverticular bottom became evident. Despite a large diverticular neck, the endoscope tip position was unstable. Nevertheless, hemostasis was achieved by placement of 2 clips at the bleeding site. The diverticulum was gently irrigated with water after the positioning of each clip. The site was observed for 5 minutes to detect further bleeding.
Three days later, the patient had a new episode of hematochezia, followed by hemodynamic instability and a decrease in hemoglobin from 10.2 to 7.1 g/dL. Given the early recurrence of bleeding, the unusual nature of the disease, and the patient’s age and comorbidities, a second endoscopic look was taken. Endoscopy revealed an active arterial oozing at the previous hemostasis site, where only 1 hemoclip was found. To stop the bleeding, 2 mL of cyanoacrylate (Glubran 2, GEM S.r.I., Viareggio, Italy) were injected in a linear vessel on the diverticular bottom.
The subsequent clinical course was uneventful.There was no recurrence of bleeding during a 3-month follow-up

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