Laparoscopic duodenal diverticulectomy following hemorrhage

A 53-year-old man on warfarin therapy for an aortic valve prosthesis suffered a massive upper gastrointestinal hemorrhage. Urgent endoscopy revealed active bleeding from the apex of a large duodenal diverticulum. Bleeding was successfully controlled with heater-probe applications, and the patient recovered uneventfully. Because of the patient's lifelong need for anticoagulation therapy, elective laparoscopic duodenal diverticulectomy was subsequently done using intraoperative endoscopic guidance. The patient returned to full activity and diet within 3 days and has remained stable during the postoperative interval. We describe here a new minimal access approach to a complicated duodenal diverticulum combining laparoscopic and endoscopic techniques.