gastro-congress-2019-scientifictracks

46 / 60

Page 46
conferenceseries.com
Volume 09 Journal of Gastrointestinal & Digestive System
ISSN: 2161-069X Gastro Congress 2019
July 08-09, 2019
July 08-09, 2019 | Zurich, Switzerland
14th Euro-Global Gastroenterology Conference
A gastric diverticulum presenting as massive intra-diverticular bleeding
Anna Melissa M. Ng and Ike T Minerva
West Visayas State University Medical Center, Philippines
Statement of the Problem: Gastric diverticula (GD) are rare and frequently asymptomatic. However, there are cases
that present with massive upper gastrointestinal bleeding (UGIB). A search by Gibbons et al., revealed only five cases
that have shown that intraluminal hemorrhage originated within the diverticulum. We report a 69-year-old female
who presented at the emergency room (ER) with massive hematemesis. She had a three-month history of heartburn,
epigastric discomfort and vomiting. She eventually developed acute respiratory failure secondary to hypovolemic
shock from UGIB. She was conscious and generally pale, with anicteric sclera and pale conjunctivae. Abdominal
examination showed a midline infra-umbilical scar, but was otherwise unremarkable.
DiagnosticWork-up: Upper Gastrointestinal Endoscopy (UGIE) revealed pooling of coffee ground mixed with fresh
blood and food materials in a diverticulum that seemed to be below the gastro-esophageal junction. Bleeding ulcers
at the middle to distal third of the esophagus were also noted. To establish diagnosis, location of the diverticulum and
possible surgical intervention, a barium meal was requested that revealed a proximal gastric diverticulum. Narrow
Band Imaging (NBI) also showed a gastric mucosa lining the diverticulum.
Treatment: The patient was offered definitive treatment through laparoscopic resection but was not amenable
during the present admission. Management included a long-term proton pump inhibitor and diet that involved
small frequent feedings.
Conclusion & Significance: Although most GD is asymptomatic, our patient presented with massive UGIB. To our
knowledge, this is the first reported case in the Philippines of GD presenting as hematemesis secondary to intra-
diverticular hemorrhage, confirmed with barium swallow and NBI.
Recommendations: A high index of suspicion is required to diagnose GD because it can lead to life threatening
complications such as massive UGIB and because definitive treatment is available and complete cure is attainable.
Recent Publications
1. Podda M, Atzeni J, Campanella AM, Saba A and Pisanu A (2016) Syncope with surprise: an unexpected finding
of huge gastric diverticulum. Hindawi Publishing Corporation. 2016: 1941293.
2. Rashid F, Aber A and Iftikhar S (2017) A review on gastric diverticulum. World Journal of Emergency Surgery.
7:1.
3. Hernandez G H, Soto I C F and Garcia C A J (2016) Gastric diverticulum: a rare endoscopic finding. Journal of
Hepatology and Gastrointestinal Disorders. 2:2.
4. Kumar P and Chandra K (2014) A case of gastric diverticulum: solitary fundal diverticulum. Indian Journal of
Clinical Practice. 25:4.
5. Feng Y and Zhang Z (2015) Gastric diverticulum stimulating a left adrenal mass: a case report and review of
related literature. Oncology Letters. 10:2477-2480.
J Gastrointest Dig Syst 2019, Volume 09