Duplication cyst of the small intestine found by double-balloon endoscopy: A case report

A 35-year-old man was admitted due to bloody stool and anemia. The bleeding source could not be detected by esophagogastroduodenoscopy or colonoscopy. Double balloon endoscopy (DBE) revealed a diverticulum-like hole in which coagula stuck in the ileum at 1 meter on the oral side from the ileocecal valve. The adjacent mucosa just to the oral side of the hole was elevated like a submucosal tumor. The lesion was considered the source of bleeding and removed surgically. It was determined to be a cyst with an ileal structure on the mesenteric aspect accompanying gastric mucosa. The diagnosis was a duplication cyst of the ileum, which is a rare entity that can cause gastrointestinal bleeding. In the present case, DBE was used to find the hemorrhagic duplication cyst in the ileum

内視鏡的に止血しえた回腸憩室出血の1例

We herein report successful endoscopic hemostasis in a patient with a bleeding from acquired ileal diverticulum. A 65-year-old woman was introduced to our hospital after the sudden onset of painless hematochezia. When emergency colonoscopy was performed, the site of bleeding could not be identified because of extensive blood pooling in the colon and ileocecal region. After admission, repeat colonoscopy with a transparent hood device after bowel preparation disclosed oozing of blood from an ileal diverticulum approximately 15 cm proximal to the ileocecal junction. We performed endoscopic therapy with injection of a hypertonic saline-epinephrine solution and placement of additional hemoclips in the diverticulum. Since the latter treatment, the patient had no recurrent hematochezia, and occult blood tests in stool had been negative. In cases of lower gastrointestinal bleeding, bleeding from an acquired ileal diverticulum should be considered and the terminal ileum carefully observed.65 歳の女性が，下血を主訴に当院に紹介された．同日，緊急下部消化管内視鏡検査を施行したが，全大腸及び回盲部に著明な凝血塊を認め，明らかな出血源は同定できなかった．当院入院後，腸管洗浄液による前処置を行い，再度下部消化管内視鏡検査を施行したところ，回腸末端から口側約15cm に凝血魂の付着を伴う憩室を認めた．吸引により漏出性の出血を認め，出血源と判断し，HSE（hypertonic saline-epinephrine）局注法及びクリップによる内視鏡的止血術を施行した．施行後明らかな出血は認めなかった．下部消化管出血が疑われる場合，回腸憩室からの出血を念頭に置き，回腸末端を丹念に観察するべきであると考えられる

Successful Endoscopic Hemostasis for Bleeding from an Acquired Ileal Diverticulum

We herein report successful endoscopic hemostasis in a patient with a bleeding from acquired ileal diverticulum. A 65-year-old woman was introduced to our hospital after the sudden onset of painless hematochezia. When emergency colonoscopy was performed, the site of bleeding could not be identified because of extensive blood pooling in the colon and ileocecal region. After admission, repeat colonoscopy with a transparent hood device after bowel preparation disclosed oozing of blood from an ileal diverticulum approximately 15 cm proximal to the ileocecal junction. We performed endoscopic therapy with injection of a hypertonic saline-epinephrine solution and placement of additional hemoclips in the diverticulum. Since the latter treatment, the patient had no recurrent hematochezia, and occult blood tests in stool had been negative. In cases of lower gastrointestinal bleeding, bleeding from an acquired ileal diverticulum should be considered and the terminal ileum carefully observed.65 歳の女性が，下血を主訴に当院に紹介された．同日，緊急下部消化管内視鏡検査を施行したが，全大腸及び回盲部に著明な凝血塊を認め，明らかな出血源は同定できなかった．当院入院後，腸管洗浄液による前処置を行い，再度下部消化管内視鏡検査を施行したところ，回腸末端から口側約15cm に凝血魂の付着を伴う憩室を認めた．吸引により漏出性の出血を認め，出血源と判断し，HSE（hypertonic saline-epinephrine）局注法及びクリップによる内視鏡的止血術を施行した．施行後明らかな出血は認めなかった．下部消化管出血が疑われる場合，回腸憩室からの出血を念頭に置き，回腸末端を丹念に観察するべきであると考えられる