Embolization Coils Migrating and Being Passed per Rectum After Embolization of a Splenic Artery Pseudoaneurysm, “The Migrating Coil”: A Case Report

Abstract

Acute or chronic blood loss from pseudoaneurysms of the splanchnic artery in chronic pancreatitis poses diagnostic and management challenges. Arteriographic examination offers both diagnostic and therapeutic options, with success rates of 76%-100% for both modalities. In cases of failure of embolization, repeat embolization is also an option. Surgical intervention is advocated for rebleeding and failure of embolization. Evidence-based guidelines regarding the optimal treatment modality for this condition are lacking. There has been a reported case of dislodgement of coil into the stomach through a gastropseudocystic fistula. We report the case of a migrating steel-wire coil through the gastrointestinal tract and splenic artery pseudoaneurysm. We highlight the potential complications of pseudoaneurysm and other available therapeutic management options.

Coil migration – a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms

“…secondary to acute pancreatitis. Shah et al 16 document the passage of two steel-wire coils from an embolised splenic artery pseudoaneurysm secondary to alcohol-related pancreatitis, via the GI tract, to be discovered in the patient's stool three weeks following embolisation. Similarly to our case, no clear communication or fistula was definitively demonstrated by Shah et al…”

“…12 Some studies have therefore described an association of radiological embolisation strategies with a decreased incidence of blood transfusion and length of hospital stay, as well as lower re-bleed and mortal- More common complications following endovascular exclusion include bleeding or re-bleeding, often requiring repeat angiography 16 and surgical intervention for ligation or repair of bleeding vessels 8 and pseudoaneurysm recurrence, 14 both of which mandate careful follow-up. Postembolisation syndrome and infarction can occur in up to 30% of splenic artery pseudoaneurysm or aneurysm exclusions, 33 although clinically significant infarction of the spleen, or other organs, is rare.…”

Massive bleeeding from upper gastrointestinal tract as a symptom of rupture of splenic artery aneurysm to stomach

“…These methods give good therapeutic results, have a short convalescence period and beneficial cosmetic effect, as well as creating better operating conditions for subsequent, elective ‘open’ surgery, should need be [3]. In case of non-ruptured SAA, laparotomic surgeries are rare and are performed only in exceptional situations, in case of inefficiency of low-invasive methods or their complications in the form of perforation of aneurism or migration of embolization coils to the lumen of the gastrointestinal tract [19]. In specific cases it may be necessary to perform circular or subtotal resection of the pancreas and splenectomy [20–22].…”

Late-occurring coil migration into the duodenum

“…Late-occurring coil migration is very rare, particularly migration into the gastrointestinal tract 1 2. We speculate that coil migration into the duodenum through the tract from an adhesive inflammatory pseudoaneurysm was associated with enteric peristalsis.…”