Abstract
Eleven patients with massive duodenal hemorrhage were treated by emergent embolization. Bleeding originated from duodenal ulcer in three patients, from duodenal tumor in one, from ruptured pancreaticoduodenal artery pseudoaneurysm in three, and from ruptured gastroduodenal artery pseudoaneurysm in four. Complete hemostasis was obtained immediately after embolotherapy in all cases. Three of these patients died during the hospitalization period, one of whom from duodenal infarction and pancreas necrosis induced by embolization. In three patients with duodenal ulcer, complete hemostasis was obtained only by the gastroduodenal artery embolization with Gelfoam particles. Seven patients with pseudoaneurysms of the gastroduodenal artery or its branches required not only blockage of blood flow from the celiac artery but also the superior mesenteric artery for complete hemostasis. Therefore, in patients presenting with duodenal hemorrhage, the possibility of dual blood supply to the duodenum should be considered. Emergent embolization represents a useful alternative to surgery for massive duodenal hemorrhage, but it carries a risk of complications in patients with previous gastroduodenal surgery or significant visceral atherosclerosis.
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Boijsen E, Gothlin J, Hallbook T, Sandblom P. Preoperative angiographic diagnosis of bleeding aneurysms of abdominal visceral arteries.Radiology 1969;93:781–791
Rahn NH, Tishler JM, Han SY, Russinovich NA. Diagnostic and interventional angiography in acute gastrointestinal hemorrhage.Radiology 1982;143:361–366
Elerding SC, Moore EE, Wolz JR, Norton LW. Outcome of operations for upper gastrointestinal tract bleeding. An update.Arch Surg 1980;115:1473–1477
Graham JM, McCollum CH, DeBakey ME. Aneurysms of the splanchnic arteries.Am J. Surg 1980;140:797–801
Bookstein JJ, Chlosta EM, Foley D, Walter JF. Transcatheter hemostasis of gastrointestinal bleeding using modified autogenous clot.Radiology 1974;113:277–285
Rösch J, Dotter CT, Brown MJ. Selective arterial embolization. A new method for control of acute gastrointestinal bleeding.Radiology 1972;102:303–306
Keller FS, Rösch J. Embolization for acute duodenal hemorrhage.Semin Intervent Radiol 1988;5:32–38
Ring EJ, Oleaga JA, Freiman D, Husted JW, Waltman AC, Baum S. Pitfalls in the angiographic management of hemorrhage. Hemodynamic considerations.AJR 1977;129:1007–1013
Granmayeh M, Wallace S, Schwarten D. Transcatheter occlusion of the gastroduodenal artery.Radiology 1979;131:59–64
Mandel SR, Jaques PF, Mauro MA, Sanofsky S. Non-operative management of peripancreatic arterial aneurysms. A 10-year experience.Ann Surg 1987;205:126–128
Gomes AS, Lois JF, McCoy RD. Angiographic treatment of gastrointestinal hemorrhage. Comparison of vasopressin infusion and embolization.AJR 1986;146:1031–1037
Waltman AC, Greenfield AJ, Noveline RA, Athanasoulis CA. Pyloroduodenal bleeding and intraarterial vasopressin. Clinical results.AJR 1979;133:643–646
Rasuli P, Desmarais RL. Gastroduodenal artery aneurysm. Treatment by transcatheter embolization.Can Med Assoc J 1983;129:581–583
Freeny PC, Bush WH, Kidd JR, Marks WM. Subselective diagnostic and interventional arteriography using a simple coaxial catheter system.Cardiovasc Intervent Radiol 1984;7:209–213
Meyerovits MF, Levin DC, Boxt LM. Superselective catheterization of small-caliber arteries with new high visibility guide wire.AJR 1985;144:785–786
Okazaki M, Ono H, Higashihara H, Koganemaru F, Nozaki Y, Hoashi T, Kimura T, Yamasaki S, Makuuchi M. Angiographic management of massive hemobilia due to iatrogenic trauma.Gastrointest Radiol 1991;16:205–211
Okazaki M, Higashihara H, Koganemaru F, Ono H, Hoashi T, Kimura T. A coaxial catheter and steerable guidewire used to embolize branches of the splanchnic arteries.AJR 1990;155:405–406
Shapiro N, Brandt L, Sprayregan S, Mitsudo S, Glotzer P. Duodenal infarction after therapeutic Gelfoam embolization of a bleeding duodenal ulcer.Gastroenterology 1981;80:176–180
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Okazaki, M., Higashihara, H., Ono, H. et al. Embolotherapy of massive duodenal hemorrhage. Gastrointest Radiol 17, 319–323 (1992). https://doi.org/10.1007/BF01888578
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DOI: https://doi.org/10.1007/BF01888578