Gastroduodenal artery embolization outcomes: complications and management.

Abstract

Gastrointestinal bleeding is defined as the acute loss of blood through the gastrointestinal tract. The most common classification is based on the source of the bleeding, dividing it into upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB), depending on whether it occurs proximal or distal to the ligament of Treitz, respectively.

Among the most frequent causes of UGIB are peptic ulcers, especially duodenal ulcers, which are particularly important when they are complicated, that is, those associated with massive bleeding, perforation, stenosis, or failure of endoscopic treatment. Bleeding can manifest as hematemesis or melena, and in the most severe cases, it can cause hypotension, tachycardia, or shock.

Initial management focuses on hemodynamic stabilization and the administration of proton pump inhibitors. Endoscopic examination is usually the first step. When bleeding is refractory or not treatable endoscopically, emergency surgery or selective arterial embolization is performed, the latter being a technique that can lead to complications.

We present the case of a 78-year-old man with a history of upper gastrointestinal bleeding due to a duodenal ulcer and multiple rebleeding episodes, who was admitted for a new episode of melena. Endoscopy revealed a large duodenal ulcer with inflammatory stenosis, not amenable to endoscopic treatment, so gastroduodenal artery embolization was performed. One month later, he was readmitted with sepsis and hemodynamic instability. A CT scan showed a penetrating duodenal ulcer with pancreatic involvement and retroperitoneal fluid collections. Ultimately, conservative management was chosen, with a satisfactory outcome.

Keywords: upper gastrointestinal bleeding, arterial embolization, conservative management, post-embolization complications.