A 42-year-old woman admitted for evaluation of hypotension and
fainting in the emergency room underwent esophagogastroduodenoscopy because of
melena and a hemoglobin concentration of 6.7 g/dL. Endoscopy showed an
ulcer 22 × 24 mm in diameter along the anterior
duodenal bulb. After the injection of 4 mL epinephrine, the vessel began
to bleed massively. Mesenteric angiography was performed urgently. The
selective celiac arterial angiogram showed the right and left hepatic arteries
arising separately from the celiac trunk. There was also severe vasospasm in
the left hepatic artery and gastroduodenal artery ([Fig. 1 a]).
Fig. 1 a Vasospasm in the left
hepatic artery and gastroduodenal artery. b
Gastroduodenal artery with platinum coil in place. c
Endoscopic visualization of the coil in the duodenal ulcer.
No aneurysm was seen because of the severe vasospasm, possibly due
to the extravasation. The gastroduodenal artery was embolized with a platinum
coil ([Fig. 1 b]). The patient underwent
endoscopy a week later, and the duodenal ulcer was seen with the coil located
in the intravascular area ([Fig. 1 c]). No
active bleeding or oozing was seen, and after stabilization of the hemoglobin
concentration the patient was discharged.
A 65-year-old man was admitted to the Ege University chest disease
clinic with pneumonia. Esophagogastroduodenoscopy was performed because of
massive hematemesis and melena. Significant active bleeding from a giant
duodenal ulcer was encountered. Mesenteric angiography was performed urgently
in order to undertake embolization of the bleeding artery. On selective
angiography after superselective catheterization of the gastroduodenal artery
a
pseudoaneurysm was observed in the duodenal branch of this main artery ([Fig. 2 a]).
Fig. 2 a Duodenal branch of the
gastroduodenal artery on selective angiography. b
Thrombosis of the aneurysm after embolization with a platinum coil.
c Endoscopic view of the coil protruding from the vessel
visible at the duodenal ulcer site.
Thrombosis of the aneurysm was seen after embolization of the
gastroduodenal artery with a platinum coil. No communication and no filling
effect of the aneurysm between the collateral branches of the superior
mesenteric artery was seen ([Fig. 2 b]).
No further bleeding occurred, and the patient was discharged after starting
proton-pump inhibitor therapy. Control esophagogastroduodenoscopy was performed
6 weeks later, and the coil was seen protruding into the lumen from the vessel
visible at the ulcer site ([Fig. 2 c]).
Endoscopy_UCTN_Code_CCL_1AB_2AZ_3AC
