Please cite this article in press as: Carvalho JR, et al. Major duodenal diverticular bleeding. Gastroenterol Hepatol. 2018. https://doi.org/10.1016/j.gastrohep.2018.10.009 ARTICLE IN PRESS +Model GASTRO-1354; No. of Pages 2 Gastroenterol Hepatol. 2018;xxx(xx):xxx---xxx www.elsevier.es/gastroenterologia Gastroenterología y Hepatología IMAGE OF THE MONTH Major duodenal diverticular bleeding Hemorragia de divertículo duodenal Joana Rita Carvalho a,*,1 , Inês Nogueira Fonseca b,1 , Carlos Freitas a , Paula Moura Santos a , Luís Carrilho Ribeiro a , Rui Tato Marinho a a Department of Gastroenterology and Hepatology, North Lisbon Hospital Centre, Hospital de Santa Maria, Portugal b Department of Internal Medicine, North Lisbon Hospital Centre, Hospital de Santa Maria, Portugal Duodenal diverticula (DD) are present in 20% of adults. 1,2 Bleeding is a rare event (0.14% of upper gastrointestinal bleeding) and there is no defined gold standard method of haemostasis. 3,4 Figure 1 (A) UE revealing blood in the giant DD; (B) during observation, an arterial spurting of the DD was seen; (C) the bleeding was controlled with epinephrine and 3 hemoclips; (D) a second look endoscopy was performed without evidence of rebleeding. * Corresponding author. E-mail address: joana.rita.carvalho@gmail.com (J.R. Carvalho). 1 Co-first authors. A 64-year-old female patient presented with melena with hemodynamic instability. At physical examination, she was tachycardic and nasogastric intubation did not show blood. Laboratory workup revealed acute normocytic https://doi.org/10.1016/j.gastrohep.2018.10.009 0210-5705/© 2018 Elsevier Espa˜ na, S.L.U. All rights reserved.