Duodenal Ulcer
Upper GI Bleeding due to a Duodenal Ulcer

Video Endoscopic Sequence 1 of 23.

Upper GI Bleeding due to a Duodenal Ulcer

This is a 58 year-old man, that was under non steroids anti-inflammatory drugs and aspirin treatment. The patient had one week evolution of intermittent melena. At the time of arrival to the Emergency unit, showed signs of hipovolemic shock and his hemoglobin was 7.2 mg/dl.

Emergency endoscopy revealed a duodenal ulcer with an active bleeding site.

For more endoscopic details download the video clips by clicking on the endoscopic images, wait to be downloaded complete then press Alt and Enter; thus you can observe the video in full screen.

All endoscopic images shown in this Atlas contain
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Injection Therapy of Bleeding Duodenal Ulcer.

Video Endoscopic Sequence 2 of 23.

Injection Therapy of Bleeding Duodenal Ulcer.

Immediately after the endoscopic diagnosis, we performed a combined an aggressive therapeutic procedure, consisting of sclerotherapy with absolute alcohol and then the placement of rubber bands. (Combined Therapeutical methods).

After the first application of alcohol, we noticed the result, the bleeding was over.

Due to the recent development of endoscopic hemostatic procedures, including clipping methods and absolute ethanol injection, the number of emergency operations for bleeding peptic ulcers has markedly declined.

 

Injection Therapy of Bleeding Duodenal Ulcer

Video Endoscopic Sequence 3 of 23.

Injection Therapy of Bleeding Duodenal Ulcer.

It is observed the sclerotherapy needle, injecting absolut alcohol on the anterior wall of the duodenal bulb.

Despite advances in medical management, gastrointestinal bleeding remains a substantial cause of morbidity and mortality.
At risk are patients with history of the event, those taking nonsteroidal antiinflammatory agents, and those with active peptic ulcer disease. Endoscopy may be performed for diagnosis and treatment. Antisecretory therapy may be employed to control gastric acid secretion, treat active peptic ulcer disease, and control symptoms such as abdominal pain.

 

Injection Therapy of Bleeding Duodenal Ulcer.

Video Endoscopic Sequence 4 of 23.

Injection Therapy of Bleeding Duodenal Ulcer.

After the injection of 0.5 cc alcohol, we removed the needle
and planned three more shots.

 

Injection Therapy of Bleeding Duodenal Ulcer.

Video Endoscopic Sequence 5 of 23.

Image of Injection Therapy of Bleeding Duodenal Ulcer.

The endoscopic procedure continues.

 

Injection Therapy of Bleeding Duodenal Ulcer.

Video Endoscopic Sequence 6 of 23.

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

The site of acute peptic ulcer bleeding was in the anterior wall of the duodenal bulb.

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

Video Endoscopic Sequence 7 of 23.

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

On the image and video the ulcer can be seen, soon after the alcohol injections.

And in order to rule out the possibility that bleeding was caused by an arterial branch with a big vessel, and therefore preventing another, we were a little more aggressive on the treatment, by placing a couple of rubbers bands.

 

Endoscopic band ligation for control of acute peptic ulcer

Video Endoscopic Sequence 8 of 23.

Endoscopic band ligation for control of acute peptic ulcer bleeding. After the hemostatic procedure with absolute ethanol injection, and in order to avoid the re-bleeding, the vessel, is suctioned into the banding apparatus.

 

The use of endoscopic band ligation is being extended to

Video Endoscopic Sequence 9 of 23.

The use of endoscopic band ligation is being extended to treat various causes of upper and lower gastrointestinal bleeding.

Endoscopic band ligation is currently considered to be the treatment of choice for esophageal variceal bleeding.

 

The use of endoscopic band ligation is being extended to

Video Endoscopic Sequence 10 of 23.

At present time, there is no consensus as to the best treatment for non-variceal, non-ulcer gastrointestinal hemorrhage.

The use of endoscopic band ligation is being extended to

Video Endoscopic Sequence 11 of 23.

Combined Therapeutical methods.

This treatment combines successfully the use of the sclerotherapy with absolute alcohol and the placement of rubber bands onto the bleeding site.

 

Duodenal Ulcer

Video Endoscopic Sequence 12 of 23.

Duodenal Ulcer

Endoscopic follow-up examination

To the sixth day of the therapeutic procedure, a new endoscopy was performed, observing the status post therapeutic treatment.

 

Duodenal Ulcer

Video Endoscopic Sequence 13 of 23.

Duodenal Ulcer

More images and video clips of the status post
therapeutic treatment.

A second-look endoscopy is often performed to evaluate the efficacy of a prior injection therapy in patients with bleeding peptic gastric or duodenal ulcers.

 

Image and video clip Duodenal Ulcer.

Video Endoscopic Sequence 14 of 23.

Image and video clip Duodenal Ulcer.

Visible vessels are observed.

It has been recommended that all visible vessels of peptic ulcers, irrespective of inactive bleeding, be treated by the endoscopic hemostatic procedure at the first endoscopy, if possible.

 

Video Endoscopic Sequence 15 of 23.

Five Years Later

Another bleed

Five years later the patient went to our office very palid ,taquicardic, and with hyportension with 2 days of being suffering of melenas. Immediately it was realized an endoscopy of emergency finding an active bleeding making a complete hemostasis with the therapeutic endoscopy.

The patient had been consuming strong doses of Ibuprofen.

 

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

Video Endoscopic Sequence 16 of 23.

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

After washing hardly, it was localized the exact site of the bleeding. One vessel exposed of a duodenal ulcer in the same zone where five years ago it had caused the same problem.

 

A spurting bleeding of the duodenal ulcer

Video Endoscopic Sequence 17 of 23.

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

A spurting bleeding of the duodenal ulcer

 

A spurting bleeding of the duodenal ulcer

Video Endoscopic Sequence 18 of 23.

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

A spurting bleeding of the duodenal ulcer

It applies injection of absolute alcohol 0.5 ml. each

 

therapeutic endoscopy inyecting many doses of absolute alcohol.

Video Endoscopic Sequence 19 of 23.

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

It continues with the therapeutic endoscopy inyecting many doses of absolute alcohol.

 

Duodenal Ulcer.

Video Endoscopic Sequence 20 of 23.

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

In total they were 4 infiltration of different quadrants around the ulcer of 0.5 ml each of absolute alcohol.

 

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

Video Endoscopic Sequence 21 of 23.

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

Across the water is observed the ulcer

 

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

Video Endoscopic Sequence 22 of 23.

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

It proceeds to place two hemoclips.

Video Endoscopic Sequence 23 of 23.

Video Endoscopic Sequence 23 of 23.

Image and video clip of Injection Therapy of Bleeding Duodenal Ulcer.

Final status of therapeutic endoscopy shows two hemoclips

 

Duodenal bulb with Two pseudo-diverticula

Video Endoscopic Sequence 1 of 1.

Pseudo diverticular scar of duodenal bulb due to sequel of duodenal ulcer.

Duodenal bulb with Two pseudo-diverticula located on the duodenal anterior wall.

 

 

Bulbo Duodenal con Pseudo divertículos

Video Endoscopic Sequence 1 of 2.

Video endoscopic image of Pseudo diverticular scar of duodenal bulb due to sequel of duodenal ulcer.

 

 

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