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A 46-year-old man presented to the emergency room with a history of two days of melena culminating with hematemesis on the morning of admission. On admission his hemoglobin and hematocrit were 8.5/24.
He immediately underwent upper endoscopy which revealed a posterior duodenal ulcer with an actively pumping arterial bleeder in its base. Attempts at endoscopic hemostasis were unsuccessful. Transfusion was initiated and the patient was taken immediately to the operating room. On opening the duodenum the pumping vessel was visualized as shown in the video and control was obtained by direct pressure.
The gastroduodenal artery lies between the first portion of the duodenum (D1) and the pancreas. Posterior/penetrating duodenal ulcers can erode into this vessel causing dramatic, life-threating upper GI hemorrhage. Even if initial endoscopic control (bicap, epinephrine injection) is successful, there is a 50% chance of recurrent bleeding because of the size of the involved vessel.
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