PICTURES IN DIGESTIVE PATHOLOGY

 

Effectiveness of arterial embolization in recurrent bleeding due to duodenal ulcer during postoperative cardiac surgery

Efectividad de la embolización arterial en el manejo de la hemorragia recurrente por ulcus duodenal en el postoperatorio de cirugía cardiaca

 

 

Caridad Marín-Hernández¹, Pablo Ramírez-Romero¹, Rubén Jara², Daniel Carbonell³ and Pascual Parrilla¹

¹Department of General Surgery, ²Intensive Care Unit, and ³Interventional Radiology Unit. Hospital Universitario Virgen de la Arrixaca. El Palmar, Murcia. Spain

 

 

Introduction

Upper gastrointestinal bleeding is one of the most frequent complications after cardiac surgery, and endoscopic treatment (ET) is often the first-choice procedure. When it fails, surgery can be an option but it has significant mortality and morbidity (1). We propose arterial embolization (transcatheter arterial embolization, TAE) as an alternative treatment in selected cases.

 

Case report

We present the case of a 60-year-old man with three vessel coronary artery disease treated with a by-pass. During the early-postoperative period he suffered an upper gastrointestinal bleeding due to multiple duodenal ulcers. Initially, endoscopic treatment was used up to five times. Due to recurrent bleeding, a selective gastroduodenal artery angiography was performed, showing continuous bleeding of the small terminal branches of duodenal arteries (Fig. 1). Gastroduodenal artery embolization was performed in the origin of the duodenal branches with Nester^® microcoils. The patient did not present other bleeding episodes.

 

 

Discussion

Upper gastrointestinal bleeding is a frequent complication after cardiac surgery with successful endoscopic management in 90% of the cases. In persistent hemorrhage cases, a surgical approach is the treatment of choice with its associated morbidity and mortality. TAE is an intermediate resource, less aggressive than surgery, with a 92% of success rate (2,3). The main disadvantage of TAE is the need for experts in these Interventional Radiology techniques to ensure success. However, multidisciplinary treatment is increasingly being accepted in referral centers.

 

References

1. Chin MW, Yong G, Bulsara MK, et al. Predictive and protective factors associated with upper gastrointestinal bleeding after percutaneous coronary intervention: A case-control study. Am J Gastroenterol 2007;102(11):2411-6. DOI: 10.1111/j.1572-0241.2007.01460.x.         [ Links ]

2. Katano T, Mizoshita T, Senoo K, et al. The efficacy of transcatheter arterial embolization as the first-choice treatment after failure of endoscopic hemostasis and endoscopic treatment resistance factors. Dig Endosc 2012;24(5):364-9. DOI: 10.1111/j.1443-1661.2012.01285.x.         [ Links ]

3. Mille M, Huber J, Wlasak R, et al. Prophylactic transcatheter arterial embolization after successful endoscopic hemostasis in the management of bleeding duodenal ulcer. J Clin Gastroenterol 2015;49(9):738-45. DOI: 10.1097/MCG.0000000000000259.         [ Links ]