Colonoscopic Removal of Arterial Embolization Coils Migrating into the Gastrointestinal Lumen: A Case Report
22 March 2018 (online)
Introduction Splenic artery pseudoaneurysms (SAP) are rare vascular injuries, mainly associated with pancreatitis. Management is generally initially attempted with transcatheter embolization. While success rates for embolization exceed 90%, complications may arise, even months after embolization.
Case Report A 68-year-old male who had previously undergone laparoscopic cholecystectomy, complicated by an abscess near the pancreatic head and bacteremia, was transferred to our institution following an episode of hematochezia. A computed tomography scan upon arrival revealed inflammation of pancreatic head, a pancreatic head pseudocyst, and splenic artery pseudoaneurysm in a branch of the splenic artery (SAP).
The SAP was successfully occluded via transcatheter coil embolization of the feeding artery and packing of the pseudoaneurysm sack. One month later, a computed tomography showed unraveled coil present in the descending colon suggesting pseudoarterio-colonic fistula. Part of this passed, but repeated imaging demonstrated additional coils outside the psueodocaneurysm sack in the retroperitoneum and in the colon. Based on a multidisciplinary discussion, a colonoscopy was performed to remove the unraveled coil from the colonic lumen and subsequent closure of fistula orifice with an over the scope clip. This was performed without complication. A computed tomography angiogram obtained immediately after the procedure demonstrated presence of the endoscopic clip and a stably thrombosed SAP. The patient was discharged the following day.
Learning Points This case report showed a rare erosion of an embolization coil into the gastrointestinal lumen, successful colonoscopic removal of embolization coils, and concurrent closure of pseudoarterio-colonic fistula. Minimally invasive endoscopic techniques spared surgical intervention.