Duodenal obstruction after successful embolization for duodenal diverticular hemorrhage: A case report

Abstract

We present a 69-year-old woman with a duodenal obstruction after successful selective transcatheter arterial embolization (TAE) for a duodenal diverticular hemorrhage. Two weeks after TAE, the patient showed abrupt symptoms of duodenal obstruction. Resolving hematomas after successful selective transcatheter arterial embolization should be thoroughly observed because they might result in duodenal fibrotic encasement featuring inflammatory duodenal wall thickening, duodenal deformity, dysmotility, and finally obstruction.

Large duodenal hematoma associated with transcatheter arterial embolization following endoscopic hemostasis in a cirrhosis patient: Case report

“…Occlusion of terminal vessels by TAE eliminates collateral flow via the precapillary arterioles (11). Extensive tissue necrosis, local intravascular thrombosis and pancreatitis have been reported as complications of embolization (12,13). In addition, submucosal epinephrine injection performed before TAE in this case is considered another important factor for tissue damage, probably leading to the development of duodenal intramural hematoma.…”

Arterial supply to the bleeding diverticulum in the ascending duodenum treated by transcatheter arterial embolization— a duodenal artery branched from the inferior pancreaticoduodenal artery

“…Of the eight previously reported cases of hemorrhagic duodenal diverticulum treated with TAE (Kwon et al 2009 ), seven were located in the descending duodenum and one in the transverse duodenum. Treatment of hemorrhagic diverticulum in the ascending duodenum by TAE is yet to be documented.…”

“…The number of embolized vasa recta in the experimental study does not always assure the safety of embolization with NBCA-Lp in human. Kwon reported a case of duodenal obstruction caused by duodenal wall thickening and periventricular fibrosis that occurred 2 weeks after TAE had been conducted for duodenal diverticular hemorrhage (Kwon et al 2009 ). In the present case, several vasa recta were occluded and a hemi-circumferential ulcer detected on the ventral wall of the ascending duodenum after TAE, was cured by conservative medicine.…”

Perforated Duodenal Diverticulum With Postoperative Diverticulum Bleeding Successfully Treated Using Transcatheter Arterial Embolization

“…While endoscopic, angiographical, and surgical treatments have been performed to achieve hemostasis, there is no consensus regarding the optimal treatment for DDB [4]. Owing to the difficulty in reaching DD via standard upper GI endoscopy, very few cases of successful endoscopic hemostasis have been reported [5], and angiographic hemostasis should be considered as the first-line treatment for DDB [6].…”