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Case Reports
. 2020 Feb 20;7(2):e00275.
doi: 10.14309/crj.0000000000000275. eCollection 2020 Feb.

Successful Hemostasis With Endoscopic Suturing of Recurrent Duodenal Ulcer Bleeding After Failed Initial Endoscopic Therapy and Embolization

Nelson T Chuang  1 , Amol Agarwal  1 , Raymond Kim  1
Affiliations
Case Reports

Successful Hemostasis With Endoscopic Suturing of Recurrent Duodenal Ulcer Bleeding After Failed Initial Endoscopic Therapy and Embolization

Nelson T Chuang et al. ACG Case Rep J. .

Abstract

Peptic ulcer bleeding is a common condition where endoscopic therapy offers a safe and definitive treatment. However, management of peptic ulcer bleeding can be more complex when there is large volume, recurrent bleeding in a critically ill patient. We present a patient with life-threatening, recurrent duodenal ulcer bleeding who failed both standard endoscopic therapy and transarterial embolization. Hemostasis was achieved through a combination of standard endoscopic therapy and endoscopic suturing.

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Figures

Figure 1.
Figure 1.
Initial endoscopy showed the (A) large ulcer on the anterior portion of the duodenal bulb with a visible bleeding vessel, pigmented spots, and an adherent clot. (B) Injection with epinephrine and application of bipolar cautery achieved hemostasis.
Figure 2.
Figure 2.
(A) The arteriogram of the common hepatic artery showed extravasation of contrast (white arrow) from the right duodenal branch of the gastroduodenal artery. (B) Successful coil embolization (black arrow) was performed.
Figure 3.
Figure 3.
Repeat endoscopy showed (A) a large ulcer on the posterior portion of the duodenal bulb with an actively bleeding visible vessel and (B) one interrupted suture was placed at the edges of the ulcer to reduce the size.
See this image and copyright information in PMC

References

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