Arterial bleeding of duodenal ulcer: endoscopic clipping

Upper GI bleeding is a common medical emergency and is much more common in the elderly. The most common presenting signs are hematemesis (bright red or 'coffee ground') and melena. About 30% of patients with bleeding ulcers present with hematemesis, 20% with melena, and 50% with both. In this video, we show the case of a 77-year-old patient who was admitted to the cardiac surgery department. The patient had undergone a mitral valve replacement one week earlier and received prophylactic heparin. He presented an episode of melena associated with fresh red blood through per rectum.

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Arterial bleeding of duodenal ulcer: endoscopic clipping

Authors

Gf Donatelli, S Perretta, B Dallemagne, J Marescaux

Abstract

Upper GI bleeding is a common medical emergency and is much more common in the elderly. The most common presenting signs are hematemesis (bright red or 'coffee ground') and melena. About 30% of patients with bleeding ulcers present with hematemesis, 20% with melena, and 50% with both. In this video, we show the case of a 77-year-old patient who was admitted to the cardiac surgery department. The patient had undergone a mitral valve replacement one week earlier and received prophylactic heparin.
He presented an episode of melena associated with fresh red blood through per rectum.

Keywords

Arterial bleeding, duodenal ulcer, endoscopic clipping

Media type

Surgical video

Duration

01'51''

Publication

2011-11

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E-publication

WeBSurg.com, Nov 2011;11(11).
URL: http://www.websurg.com/doi-vd01en3479.htm

Arterial bleeding of duodenal ulcer: endoscopic clipping

1. Clinical case 00'08''

In this video, we show the case of a 77-year-old patient who was admitted to the cardiac surgery department. The patient had undergone a mitral valve replacement one week earlier and received prophylactic heparin. He presented an episode of melena associated with fresh red blood through per rectum. The hemoglobin level dropped to 3 g/dL and the patient became instable, presenting with tachycardia. While fluid repletion was started to stabilize the patient, an emergency upper endoscopy was carried out under oral intubation.

2. Emergency endoscopy 00'43''

No blood was visualized in the esophagus or in the stomach. The scope was passed through the pylorus on the anterior bulbar wall.

3. Bleeding identification 00'52''

An active arterial vessel bleeding was visualized and classified as a Forrest Ia ulcer.

4. Clips placement 00'57''

In order to achieve hemostasis, three QuickClip2™ (by Olympus®) were placed, and immediately after placement of the first clip, the bleeding stopped. Two additional clips were placed for security purposes.

5. Forrest IIb ulcer identification 01'07''

During thorough exploration of the bulb, a Forrest IIb ulcer was visualized on the posterior wall of the bulb in front of the first ulcer, thereby evocative of “kissing ulcers”.

6. Clip placement 01'22''

A clip was placed on the adherent clot in the middle. The patient did well, was kept NPO for 24 hours, and on full-dose PPI. On the next day, one episode of melena occurred without deglobulization. He was discharged one week later and no new bleeding occurred at one-month follow-up.