Clin Endosc.  2019 Nov;52(6):612-615. 10.5946/ce.2019.020.

Massive Duodenal Bleeding after the Migration of Endovascular Coils into the Small Bowel

• Choi CJ
• Lim H
• Kim DS
• Jeong YS
• Park SY
• Kim JE

• KMID: 2465805
• DOI: http://doi.org/10.5946/ce.2019.020

Abstract

Among gastrointestinal emergencies, acute upper gastrointestinal bleeding remains a challenging clinical problem owing to significant patient morbidity and costs involved in management. Endoscopic hemostatic therapy is the mainstay of treatment and decreases the incidence of re-bleeding, the need for surgery, morbidity, and mortality. However, in 8%-15% of patients with upper gastrointestinal bleeding, endoscopic hemostatic therapy does not successfully control bleeding. Trans-arterial coil embolization is an effective alternative treatment for endoscopic hemostatic failure; however, this procedure can induce adverse outcomes, such as non-target vessel occlusion, vessel dissection and perforation, and coil migration. Coil migration is rare but causes severe complications, such as re-bleeding and bowel ischemia. However, in most cases, coil migration is local and involves spontaneous healing without serious complications. Here, we report the case of a patient who underwent trans-arterial coil embolization of the gastroduodenal artery with the purpose of controlling massive duodenal bleeding, resulting in a fatal outcome caused by coil migration.

Keyword

Coil migration; Endoscopy; Peptic ulcer hemorrhage; Trans-arterial embolization; Upper gastrointestinal bleeding

MeSH Terms

Arteries
Embolization, Therapeutic
Emergencies
Endoscopy
Fatal Outcome
Hemorrhage*
Humans
Incidence
Ischemia
Mortality
Peptic Ulcer Hemorrhage

Figure

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  Fig. 1. Angiography image showing significant contrast extravasation at the proximal portion of the gastroduodenal artery (A). Plain radiography image showing multiple micro-coils in the successfully occluded gastroduodenal artery in the last stage of embolization (B).

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  Fig. 2. Esophagogastroduodenoscopy image showing the migration of the embolized coil into the duodenum.

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  Fig. 3. Plain radiograph from the time of discharge showing no change in the position of the migrated coils (white arrow).

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  Fig. 4. Follow-up plain radiograph showings coil migration at 5 days after discharge (white arrows).

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