Bleeding From a Lateral Duodenal Diverticulum Complicated by a Retroperitoneal Perforation After Endoscopic Clipping

Duodenal diverticula (DD) are commonly encountered in the periampullary region but rarely on the lateral wall of the duodenum. They can develop complications such as diverticulitis, bleeding, and perforation. A 69-year-old healthy woman presented with melena due to a bleeding lesion in a lateral DD that was treated with hemoclipping. Two days later, she developed fever, hypotension, and an elevated CRP with mild abdominal pain and had no signs of peritonitis. A CT scan with oral contrast showed a large diverticulum at the junction of the descending and horizontal part of the duodenum and a perforation with minimal clinical symptoms that was successfully treated conservatively. Although causality could not be established, a retroperitoneal perforation following endoscopic hemostasis was a suspected complication of hemostatic clipping. Physicians should have a low threshold for a CT scan in the case of raised fever or inflammatory markers following endoscopic management of DD.