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Published on: September 28, 2019
Gastroduodenal artery coiling to curb upper gastrointestinal bleeding
Krishnamurti A Rao1, Ramsey Al-Hakim2, Thomas Scagnelli2
1DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL.
Insights
Coil embolization of the gastroduodenal artery effectively controlled upper gastrointestinal bleeding in a pediatric peptic ulcer case. This case report highlights a novel treatment for pediatric peptic ulcer disease.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
Background:
- Peptic ulcers are rare in children and can cause severe upper gastrointestinal bleeding.
- Endoscopy is used for diagnosis, but angiography is key for definitive bleeding control.
- The efficacy of coil embolization for pediatric peptic ulcers is not well-established.
Observation:
- A 15-year-old male with a history of peptic ulcer disease presented with significant upper gastrointestinal bleeding.
- Angiography identified the bleeding source, leading to coil embolization of the gastroduodenal artery.
- While coils eroded into the intestinal lumen, hemorrhagic control was achieved.
Findings:
- Coil embolization of the gastroduodenal artery is a viable option for managing severe bleeding from pediatric peptic ulcers.
- Successful hemorrhage control was achieved despite an unusual complication of coil erosion.
Implications:
- This case suggests coil embolization can be an effective treatment for pediatric peptic ulcer bleeding.
- Further research is needed to evaluate the long-term outcomes and safety of this procedure in pediatric patients.
Background:
Peptic ulcers in pediatric populations are uncommon and can present with upper gastrointestinal bleeding and shock on presentation. An endoscopy is done initially to identify bleeding source. However, definitive treatment is achieved with angiography. The use of coiling is effective in achieving hemorrhagic control in duodenal ulcers or gastric ulcers, particularly in adults. However, the use in pediatric populations is unknown. We present a case of peptic ulcer disease treated with a gastroduodenal artery coil in a pediatric patient that has never been reported in the literature.
Case Presentation:
A 15-year-old male with a five-year history of peptic ulcer disease was admitted with an upper gastrointestinal bleed. Angiographic imaging was done to isolate and locate the bleeding, and coil embolization of the gastroduodenal artery was performed. Coils eroded into intestinal lumen but bleeding was controlled.
Conclusion:
Peptic ulcers in pediatric populations are rare and complex in nature. Besides aggressive resuscitation and endoscopy, other methods to control bleeding such as coil embolization can be performed. Further investigations are needed to understand long-term effects of coil embolization in pediatric peptic ulcer patients.
Level Of Evidence:
5/Case Report/.
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