Angiography-assisted computed tomography for the detection and intervention of a subtle aneurysm of the omentum

Abstract

Intra-abdominal hemorrhage caused by omental artery rupture is a rare condition traditionally diagnosed via exploratory laparotomy in hemodynamically unstable patients. We experienced a case in which contrast-enhanced multidetector computed tomography (MDCT) and digital subtraction angiography did not identify the rupture site, whereas CT during left omental arteriography depicted a small 4-mm aneurysm. The lesion was then embolized with microcoils and N-butyl cyanoacrylate lipiodol glue. We consider that performing a CT during selective arteriography could be useful in cases in which the rupture site is unclear with other imaging techniques such as contrast-enhanced MDCT and digital subtraction angiography.

Left omental artery bleeding in two patients with segmental arterial mediolysis successfully isolated with coil embolization

“…In previous case reports describing OA bleeding, the culprit bleeding from the OA was not successfully embolized with coils (Rott and Boecker 2018;Tsuchiya et al 2009;Matsumoto et al 2011;Takahashi et al 2012;Tajima et al 2014;Nishiyama et al 2018). This failure can be explained by the following two major reasons: the first is failed selective catheterization of the targeted bleeding omental artery; (i) because the omental artery can arise from splenic artery or right gastroepiploic artery with acute angle (Rott and Boecker 2018;Tsuchiya et al 2009;Matsumoto et al 2011;Takahashi et al 2012;Tajima et al 2014;Nishiyama et al 2018); (ii) because the omental artery is small in diameter and long-tortuous trajectory (Rott and Boecker 2018;Tsuchiya et al 2009;Matsumoto et al 2011;Takahashi et al 2012;Tajima et al 2014;Nishiyama et al 2018); the second is the underrecognized potential for the greater omentum to have arterial collateral network between OAs (Yasuoka et al 2008;Tsuchiya et al 2009;Settembre et al 2018). In Case 1, triaxial catheter system was effective to overcome the difficulties of (i) and (ii) (Kaminou et al 1998) and then embolization using isolation technique with coils was successfully performed.…”

“…One case was treated with surgical intervention, while the other two failed TAE with coils (Yasuoka et al 2008;Rott and Boecker 2018). For non-SAM OA bleeding associated with many underlying diseases and conditions, superselective cannulation into OA followed by TAE with coils has not been successfully performed (Tsuchiya et al 2009;Matsumoto et al 2011;Takahashi et al 2012;Tajima et al 2014;Nishiyama et al 2018).…”