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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2018; 02(03): 207-210
DOI: 10.1055/s-0038-1676158
Letter to the Editor
Indian Society of Vascular and Interventional Radiology

Active Overt Obscured Gastrointestinal Bleeding Due to Ectasia of the Anterior Inferior Pancreaticoduodenal Artery and Its Endovascular Management in a Treated Case of Superior Mesenteric Artery Stenosis

Nischal G. Kundaragi
1   Department of Interventional Radiology, Aster CMI Hospital, Bengaluru, Karnataka, India
,
Naresh Bhat
2   Department of Gastroenterology and Liver Disease, Aster CMI Hospital, Bengaluru, Karnataka, India
,
N. K. Anupama
2   Department of Gastroenterology and Liver Disease, Aster CMI Hospital, Bengaluru, Karnataka, India
,
Sudhir Kale
3   Department of Radiology, Aster CMI Hospital, Bengaluru, Karnataka, India
› Author Affiliations
Further Information

Publication History

Received: 18 July 2018

Accepted after revision: 20 August 2018

Publication Date:
27 November 2018 (online)

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The term overt obscure gastrointestinal bleeding (OGIB) is defined as patients presenting with either hematochezia or melena, in whom upper and lower endoscopic examinations in addition to a small bowel (SB) series (radiographic/fluoroscopy examination of SB with positive contrast) did not reveal any source of bleeding in the gastrointestinal (GI) tract and may represent a source of bleeding outside the SB.[1] [2] In 85 to 90% of cases with OGIB, a source can be identified,; however, in 5 to 10%, no source of bleeding is found. OGIB from the small intestines is difficult to localize.[1] Small intestinal bleeding is among the less common causes of GI bleeds and accounts for ~5 to 10% of cases. According to the American College of Gastroenterology (ACG) clinical guidelines, in acute overt GI bleeding, conventional angiography should be performed on an emergency basis for hemodynamically unstable patients and computed tomography angiography (CTA) can be performed in hemodynamically stable patients to identify the site of bleeding and to guide further management.[2] The present case report is a description of a rare case of acute overt massive upper GI bleed, 1 month after superior mesenteric artery stenting. Source of bleeding was not found on upper and lower GI endoscopy and CTA. Catheter-based angiography identified anterior inferior pancreaticoduodenal artery (AIPDA) ectasia, which was subsequently embolized successfully.

 

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