Gastrointestinal bleeding from supraduodenal artery with aberrant origin

Area of Science:

• Interventional Radiology
• Gastroenterology
• Vascular Imaging

Background:

• Acute upper gastrointestinal hemorrhage (AUGIH) poses significant clinical challenges.
• Endoscopic interventions are first-line treatments but can be insufficient for severe or recurrent bleeding.
• Angiography and endovascular embolization offer alternative management strategies.

Observation:

• A patient with recurrent, life-threatening AUGIH despite multiple endoscopic treatments and prior gastroduodenal artery embolization was studied.
• The patient's refractory bleeding persisted, necessitating further investigation.
• Diagnostic angiography was performed to identify the bleeding source.

Findings:

• Angiography successfully identified the supraduodenal artery as the source of the refractory upper gastrointestinal bleed.
• Empiric embolization was performed, leading to successful hemorrhage control.
• The supraduodenal artery, though atypical, was the critical culprit in this challenging case.

Implications:

• Angiography is vital for diagnosing and managing acute upper gastrointestinal bleeding, especially when endoscopic methods fail.
• Empiric embolization should be considered in refractory cases.
• The supraduodenal artery must be recognized as a potential source of severe upper gastrointestinal hemorrhage.