Research
Use of Transcatheter Arterial Embolization in High Risk Patients with Upper Gastrointestinal Bleeding
Upper gastro intestinal bleeding is a common presentation to the Emergency Department; aproportion of these bleeds are secondary to duodenal ulcers. The management of thesein young, fit patients who can tolerate a second bleed physiologically is well established. However in the elderly frail patient a second bleed may be terminal. Options for treatment for these blee ding duodenal ulcers (apart from resuscitation, including transfusion if need be and medical management with intra venous Proton Pump Inhibitors), include endoscopic control, laparotomy with under running of the bleeding artery and endovascular approaches. 98 percent of patients can be successfully managed with endoscopy and epinephrine injection, coagulation and / or clipping of the bleeder. The dilemma exists in those patients whom are high risk for surgical intervention (laparotomy) should a re-bleed occur. In these patients transcatheter arterial embolization has become a favourable treatment modality and especially in high risk patients, selective transcatheterembolisationhas been established as a safe approach (1,2,3,5,9). In this case report we discuss the management of a 98 year old male with a duodenal ulcer with stigmata of recent bleed who presented to our department in a rural setting in Victoria, Australia.
Perforated Duodenal Diverticulum: Diagnosis and Management
Duodenal diverticula occur in up to 20% of the general population and are generally asymptomatic. Duodenal diverticula occur in up to 20% of the general population and are generally asymptomatic. Complications such as perforation are exceedingly rare, with only 101 cases reported in the literature.1 Early diagnosis is a challenge and clear guideline for the management of this rare entity is still lacking. We present a case of a 50 year-old man who was admitted to our institution with a perforated duodenal diver-ticulum. The diagnosis was achieved by contrast CT imaging of his abdomen and he was subsequently managed conservatively with nasogastric decom-pression and broad-spectrum antibiotics.
