A rare case of endoscopic visualization of a metallic coil in a duodenal ulcer after transcatheter arterial embolization

Abstract

Transcatheter arterial embolization is the therapy of choice for recurrent peptic ulcer bleeding refractory to standard endoscopic hemostatic techniques. It offers a minimally invasive approach with high efficacy, lower mortality, and complication rates compared to surgery. However, rare adverse events attributed to coil migration including pulmonary embolism, stroke, myocardial infarction, and bowel obstruction have been reported. We report the case of a 72-year-old female with a massive duodenal ulcer bleed refractory to endoscopic hemostatic techniques of epinephrine injection and bipolar cautery. She had a successful transcatheter arterial embolization of the culprit vessels. Repeat esophagogastroduodenoscopy for increasing vasopressor requirements and transfusion unresponsive anemia revealed the visualization of the metallic coil in the duodenal ulcer base with no active bleeding which was successfully managed conservatively through multidisciplinary consultation.

Keywords: coil embolization; esophagogastroduodenoscopy; peptic ulcer disease; upper gastrointestinal bleeding.

Figure 1

Endoscopic image showing the large duodenal ulcer after achievement of hemostasis with epinephrine injections and bipolar cautery.

Figure 2

Computed tomography angiography abdomen axial view showing massive arterial bleeding in the first and second portions of the duodenum.

Figure 3

Celiac angiographic view showing embolization coils in a branch of the gastroduodenal artery.

Figure 4

Endoscopic view showing a visible embolization coil at the center of the duodenal ulcer with no active bleeding.