Endoscopic View of Embolization Coil in a Duodenal Ulcer

Achado Endoscópico de Coil de Embolização em Úlcera Duodenal

Rita Vale Rodrigues^a,*, Joana Saiote^b, Tiago Bilhim^c

^a Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal

^b Gastroenterology Department, Centro Hospitalar Lisboa Central, Lisbon, Portugal

^c Radiology Department, Centro Hospitalar Lisboa Central, Lisbon, Portugal

Keywords: Duodenal Ulcer, Embolization, Therapeutic, Foreign Bodies

Palavras-chave: Úlcera Duodenal, Embolização Terapêutica, Corpos Estranhos

A 81-year-old woman with previous history of ulcerative colitis under corticotherapy was admitted to the emergency room with a two-day history of melena with orthostatic hypotension and severe anemia (hemoglobin level of 5.2 g/dL). Emergency upper endoscopy was performed and a large deep ulcer with a pulsatile visible vessel was seen along the posterior aspect of the duodenal bulb (Fig. 1). Hemostatic therapy with injection of 6 mL of epinephrine (100 μg/mL) was carried out. Due to its large size, posterior location, and associated risk of recurrent bleeding in this high-risk patient, no further endoscopic therapeutic maneuvers were performed. The patient underwent mesenteric angiography with selective embolization of the superior pancreaticoduodenal artery. The anterior branch had a pseudoaneurism that was selectively embolized with 3–5 mm platinum coils (Figs. 2 and 3). The patient underwent endoscopy 72 h later which showed a coil protruding into the lumen from the visible vessel at the ulcer site (Fig. 4). There was no active bleeding or oozing. No bleeding event was detected within 30 days after the performed treatment.

The embolization of the gastroduodenal artery is a safe and effective technique in bleeding duodenal ulcer in patients with high surgical risk. The endoscopic view of arterial embolization coils is a rare but known complication.^1–5 Due to the small number of described cases, the prognostic value of this finding with regard to rebleeding incidence remains unclear.

References

1. Vleggaar FP, Rutgers DR. Endovascular coil visible in a visible vessel. Endoscopy. 2007;39(Suppl. 1):E203.         [ Links ]

2. Singh G, Denyer M, Patel JV. Endoscopic visualization of embolization coil in a duodenal ulcer. Gastrointest Endosc. 2008;67:351-2.         [ Links ]

3. Vardar R, Ozütemiz O, Parildar M. Endoscopic view of intravascular platinum coil after embolization of bleeding duodenal ulcer: report of two cases. Endoscopy. 2009;41(Suppl. 2):E125-6.         [ Links ]

4. Mohandas N, Swaminathan M, Vegiraju V, Murthy K.V, Kulkarni A, Leelakrishnan V, et al. Endovascular coil migration and upper gastrointestinal bleed: a causal or casual relationship?. Endoscopy. 2015;47(Suppl. 1):E389-90.         [ Links ]

5. Jaurigue MM, Snyder M, Cannon M. Recurrent upper GI bleeding secondary to coil migration in a patient with known NSAID-induced peptic ulcer disease. Gastrointest Endosc. 2014;79:1004.         [ Links ]

Protection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data. The authors declare that no patient data appear in this article.

Right to privacy and informed consent. The authors declare that no patient data appear in this article.

Conflicts of interest

The authors have no conflicts of interest to declare.

^* Corresponding author.

E-mail address: rita.vale.rodrigues@gmail.com (R. Vale Rodrigues).