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- W2912129369 abstract "A 41 year-old African American woman presented to the Emergency department reporting six episodes of hematemesis during the preceding 12 hours. While in the emergency department she had a witnessed episode of hematemesis with red blood and clots. Upon further questioning, she also reported vague abdominal pain during the month prior to presentation. She denied any use of NSAIDs, illicit drugs, or symptoms of dysphagia. Pertinent past medical history included HIV/AIDS with a CD4 of 96, chronic thrombocytopenia, and a recent admission for idiopathic pancreatitis 1 month prior to the current presentation. Physical examination revealed a thin woman who was drowsy, but arousable. Rectal exam showed melena. She was afebrile. Blood pressure was 98/46 mmHg with a regular pulse of 84 bpm. Labs on presentation showed Hgb of 6.5g/dL, Hct 20%, and platelets of 20 x103/L. A comprehensive metabolic panel and acute abdominal series were unremarkable. She was resuscitated and underwent urgent upper endoscopy which revealed an esophageal diverticulum with active arterial bleeding. A non-bleeding Mallory-Weiss tear was also noted. The remainder of the EGD was unremarkable. The bleeding esophageal diverticulum was injected with diluted epinephrine and 5 hemostatic clips were placed, achieving hemostasis. She remained in the hospital after the procedure and was maintained on PPI with a stable hemoglobin and no evidence or repeat bleeding. Bleeding esophageal diverticulum is a rare occurrence. Esophageal diverticula are uncommon, with an estimated prevalence of 0.015-2%1. True esophageal diverticula, as in this case, are small and do not have the appearance of a Zenker's or epiphrenic diverticulum. This case reports successful hemostasis of an actively bleeding esophageal diverticulum with epinephrine injection and hemostatic clips. To our knowledge this is the second published case of successful hemostasis of a bleeding esophageal diverticulum with dual modality therapy2. Providers should be aware of rare causes of hematemesis and the endoscopic options available to achieve hemostasis in these patients.Figure: Bleeding esophageal diverticulum.Figure: Diverticulum after clipping." @default.
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- W2912129369 date "2017-10-01" @default.
- W2912129369 modified "2023-09-27" @default.
- W2912129369 title "An Unusual Case of Hematemesis" @default.
- W2912129369 doi "https://doi.org/10.14309/00000434-201710001-01887" @default.
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