Multiple Duodenal Diverticula: A Rare Cause of Massive Upper Gastrointestinal Bleeding and Hemodynamic Instability
Bibliographic record
Abstract
Duodenal diverticula are usually asymptomatic and identified incidentally on imaging studies. In this report, we present a case of massive gastrointestinal (GI) bleeding from multiple duodenal diverticula. A 43-year-old man was evaluated for lightheadedness, hematemesis, and melena. Patient was hypotensive and resuscitated with intravenous fluids and blood products. Upper endoscopy revealed multiple diverticula in the bulb, sweep and second portion of the duodenum with active bleeding from specific diverticulum. Epinephrine was injected around the bleeding diverticulum and multiple endoclips were applied. Patient continued to have persistent melena and required multiple units of packed red blood cells. Repeat endoscopy showed active bleeding from another duodenal diverticulum controlled with endoclips. Patient still had persistent bleeding, thus angiography was performed. Celiac artery stenosis was visualized with poststenotic dilatation. Embolization of the gastroduodenal artery could not be performed due to its retrograde flow supplying the hepatic artery proper. Patient underwent exploratory laparotomy with no further bleeding visualized through a gastrostomy. Duodenum diverticulum is a rare cause of massive upper GI hemorrhage. Endoscopy might not be successful in identifying the bleeding site. There is a high incidence of re-bleeding with endoscopic interventions. Surgery remains the definitive treatment in cases with life-threatening hemorrhage. J Med Cases. 2015;6(10):444-446 doi: http://dx.doi.org/10.14740/jmc2229w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".