十二指腸下行脚に発生した多発性出血性十二指腸潰瘍の１例

We report a case of multiple hemorrhagic ulcers of the descending duodenum treated successfullysurgical suture and endoscopic clipping after transcatheter arterial embolization（TAE）. A50 level year-old man was treated in intensive care unit because of multiple organ failure by MRSAinfection after operation of ulcerative colitis. Massive intermittent melena from ileostomy wasoccurred and an endoscopic examination revealed mucosal erosion with massive bleeding from theVater’s papilla. Emergency abdominal angiography was performed because the condition of thepatients was poor. Angiography of common hepatic artery and gastroduodenal artery didn’tshow extravasation. An extravasation of the inferior pancreaticoduodenal artery was revealedand a hemostasis was performed with metal coil embolization. But the hemorrhage occurred repeatedlythree days after TAE. We embolized the gastroduodenal artery and the pancreaticoduonenalartery. We performed surgery after three times TAE. We identified the duodenalulcer with an exposed blood vessel beside the Vater’s papilla and complete hemostasis wasachieved by suturing ulcer through the incision of the anterior wall of the duodenum. The otherhemorrhagic duodenal ulcer of the 2nd portion occurred 25 days after the operation, and this hemorrhagecould be treated by the endoscopic hemostasis using clip.