{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T14:23:23Z","timestamp":1781101403408,"version":"3.54.1"},"reference-count":27,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2001,7,1]],"date-time":"2001-07-01T00:00:00Z","timestamp":993945600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2001,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A duodenal diverticulum (DD) appears in 2.5% of upper gastrointestinal (UGI) examinations and up to 22% of endoscopie retrograde cholangiopancreaticographies (ERCP) and autopsies. Most of these patients are asymptomatic, but the lesion is occasionally associated with bleeding, inflammation, perforation, obstruction of the duodenum or biliary\u2010pancreatic duct (or both), fistula formation in the bile duct, and bezoar formation inside the diverticulum. A total of 816 patients have undergone ERCP examination at our institution since January 1987, and 100 (12.25%) of them have DD. Seven (7%) patients presented with bloody or tarry stools from massive UGI bleeding followed by shock. Only two could be diagnosed by UGI endoscopy preoperatively. The lesions were demonstrated in angiographie studies in another four cases. However, only one was correctly interpreted and one required reoperation after a correct repeat endoscopie finding. The lesions in the other two patients were identified by thorough exploration during laparotomy. The remaining case was diagnosed by intraoperative endoscopy via pyloroduodenotomy. Six underwent surgical intervention, and one was successfully treated by expectant treatment. Three (50%) had leakage from the duodenotomy but recovered uneventfully with conservative treatment. In conclusion, we believe that DD bleeding is more frequent than usually thought. A high index of suspicion should be raised in cases of UGI bleeding when more obvious and common causes have been excluded by routine endoscopy. Aggressive but careful endoscopie examination combined with accurate angiography can help us diagnose most of the cases preoperatively. Diverticulectomy is an effective surgical procedure, though it is associated with a considerable leakage rate. The morbidity is minimal if we can identify the lesion earlier and evacuate the lesion without delay.<\/jats:p>","DOI":"10.1007\/s00268-001-0039-y","type":"journal-article","created":{"date-parts":[[2003,10,27]],"date-time":"2003-10-27T18:06:14Z","timestamp":1067277974000},"page":"848-855","source":"Crossref","is-referenced-by-count":54,"title":["Clinical analysis and literature review of massive Duodenal diverticular bleeding"],"prefix":"10.1002","volume":"25","author":[{"given":"Wen\u2010Yao","family":"Yin","sequence":"first","affiliation":[{"name":"Department of Surgery Tzu\u2010Chi Dalin General Hospital No. 2, Min\u2010Sheng Road Dalintown, Chia\u2010Yi Taiwan Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwa\u2010Tzong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery Tzu\u2010Chi Dalin General Hospital No. 2, Min\u2010Sheng Road Dalintown, Chia\u2010Yi Taiwan Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih\u2010Ming","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Medicine Buddhist Tzu\u2010Chi Medical Center No. 707, Section 3, Chung\u2010Yang Road Hualien Taiwan Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsien\u2010Hong","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Medicine Buddhist Tzu\u2010Chi Medical Center No. 707, Section 3, Chung\u2010Yang Road Hualien Taiwan Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzu\u2010Ming","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Surgery Tzu\u2010Chi Dalin General Hospital No. 2, Min\u2010Sheng Road Dalintown, Chia\u2010Yi Taiwan Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2001,7]]},"reference":[{"key":"e_1_2_1_2_1","first-page":"33","article-title":"Historie de 1\u2019Acad\u00e9mie Royale, Paris, Institut de France","volume":"171","author":"Chromel J.B.L.","year":"1710","journal-title":"Acad\u00e9mie des Sciences"},{"key":"e_1_2_1_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010195113450\u201000007"},{"key":"e_1_2_1_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1966.01320190154034"},{"key":"e_1_2_1_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197002000-00007"},{"key":"e_1_2_1_6_1","first-page":"185","article-title":"Massive gastrointestinal hemorrhage from duodenal diverticula","volume":"610","author":"Lapin R.","year":"1974","journal-title":"Am. 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