Endoscopy 2007; 39: E203
DOI: 10.1055/s-2007-966414
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Endovascular coil visible in a visible vessel

F.  P.  Vleggaar1 , D.  R.  Rutgers2
  • 1Department of Gastroenterology, University Medical Center Utrecht, The Netherlands
  • 2Department of Radiology, University Medical Center Utrecht, The Netherlands
Further Information

F. P. Vleggaar

UMC Utrecht

Heidelberglaan 100
3584 CX Utrecht
The Netherlands

Fax: +31-30-2505533

Email: f.vleggaar@umcutrecht.nl

Publication History

Publication Date:
05 July 2007 (online)

Table of Contents

A 59-year-old woman collapsed while she was being admitted for chemotherapy for stage IV ovarian cancer. After large-volume resuscitation, upper gastrointestinal endoscopy was performed because of hematemesis. A large ulcer (2 × 2 cm) in the posterior wall of the duodenal bulb with a large, actively bleeding visible vessel (estimated diameter 5 - 6 mm) was seen. Despite repeated local epinephrine injections, heater probe coagulation and endoscopic clipping, arterial bleeding persisted. These endoscopic hemostatic techniques probably failed because the diameter of the bleeding vessel was too large; endoscopic visibility was bad due to persistent fulminant bleeding and the location of the ulcer [1] [2]. Emergency surgery was considered too invasive because of the patient’s medical history. Angiography showed massive duodenal bleeding after contrast injection in the gastroduodenal artery. Multiple endovascular coils were successfully placed both distal and proximal to the bleeding focus. [Figure 1] shows selective angiography of the common hepatic artery. Multiple coils are present in the gastroduodenal artery, obstructing the passage of contrast fluid. The patient recovered soon after this intervention. After 4 days, upper gastrointestinal endoscopy was performed because of a slight decrease in the hemoglobin level. A coil was clearly seen in the center of the visible vessel ([Figure 2]).

Zoom Image

Figure 1 Selective angiography of the common hepatic artery showing multiple coils in the gastroduodenal artery resulting in hemostasis.

Zoom Image

Figure 2 Endoscopic view of the base of the ulcer with a coil located in the center of the previously bleeding vessel.

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References

F. P. Vleggaar

UMC Utrecht

Heidelberglaan 100
3584 CX Utrecht
The Netherlands

Fax: +31-30-2505533

Email: f.vleggaar@umcutrecht.nl

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References

F. P. Vleggaar

UMC Utrecht

Heidelberglaan 100
3584 CX Utrecht
The Netherlands

Fax: +31-30-2505533

Email: f.vleggaar@umcutrecht.nl

Zoom Image

Figure 1 Selective angiography of the common hepatic artery showing multiple coils in the gastroduodenal artery resulting in hemostasis.

Zoom Image

Figure 2 Endoscopic view of the base of the ulcer with a coil located in the center of the previously bleeding vessel.