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Massive Upper Gastrointestinal Bleeding Following LAMS (Lumen-Apposing Metal Stent) Placement
Bhavesh Gajjar1, Tyler Aasen1, Puneet Goenka1
1East Tennessee State University, Johnson City, TN, USA.
Journal of Investigative Medicine High Impact Case Reports
|October 15, 2020
Summary
Lumen-apposing metal stents (LAMS) can cause rare but life-threatening splenic artery pseudoaneurysms, leading to massive gastrointestinal bleeding. Prompt diagnosis and intervention are crucial for patient survival.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Vascular Surgery
Background:
- Pancreatic pseudocysts often require endoscopic decompression.
- Lumen-apposing metal stents (LAMS) are increasingly used for endoscopic cystogastrostomy due to their efficacy and ease of use.
- LAMS facilitate direct endoscopic necrosectomy for walled-off necrosis.
Observation:
- A 30-year-old male with chronic pancreatitis presented with massive hematemesis and dizziness following LAMS placement for a pancreatic pseudocyst.
- Esophagogastroduodenoscopy revealed bleeding from the LAMS, and CT angiography identified a ruptured splenic artery pseudoaneurysm (PA).
Findings:
- The patient's massive gastrointestinal bleeding was attributed to a ruptured splenic artery pseudoaneurysm, a rare delayed complication of LAMS placement.
- Endovascular coiling of the splenic artery successfully managed the pseudoaneurysm, leading to patient recovery.
Implications:
- Ruptured pseudoaneurysms secondary to LAMS represent a significant, albeit rare, risk, potentially leading to high mortality if not diagnosed and treated promptly.
- This case underscores the importance of considering LAMS-related vascular complications in patients presenting with gastrointestinal bleeding after stent placement.
- Early recognition and management of pseudoaneurysms are critical for improving outcomes in patients undergoing LAMS procedures.
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