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Duodenal ulcer bleeding from a branch of the middle colic artery: A case report
Yutaka Shishido1, Eisei Mitsuoka1, Yuma Tanigawa1
1Department of Gastrointestinal Surgery, Shinko Hospital, Kobe, Hyogo, Japan.
Insights
This case report details a rare instance of duodenal ulcer bleeding originating from the middle colic artery (MCA). Transcatheter arterial embolization (TAE) successfully stopped the bleeding, highlighting the importance of thorough investigation for unusual bleeding sources.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Vascular Surgery
Background:
- Duodenal ulcer bleeding is a critical condition often linked to duodenal artery erosion.
- Prompt diagnosis and intervention are crucial for managing life-threatening gastrointestinal hemorrhage.
Observation:
- A 55-year-old male presented with abdominal pain, duodenal wall thickening, and a cystic lesion.
- Esophagogastroduodenoscopy revealed severe duodenal stenosis, hindering endoscopic evaluation.
- Massive hematochezia indicated significant gastrointestinal bleeding.
Findings:
- Emergency angiography identified duodenal ulcer bleeding from the gastroduodenal artery, inferior pancreaticoduodenal artery branch, and middle colic artery (MCA).
- Transcatheter arterial embolization (TAE) was performed on these vessels for hemostasis.
Implications:
- TAE successfully achieved hemostasis, and the patient later underwent surgery for duodenal stenosis.
- This case underscores the necessity of considering atypical bleeding vessels, such as the MCA, in refractory upper gastrointestinal bleeding.
- Thorough angiographic evaluation is vital for identifying unexpected culprit arteries in severe bleeding cases.
Rationale:
Duodenal ulcer bleeding is a potentially life-threatening condition commonly caused by the erosion of the duodenal arteries.
Patient Concerns:
A 55-year-old male was referred to our hospital with abdominal pain for the past 3 days. Contrast-enhanced computed tomography of the abdomen revealed wall thickening in the descending part of the duodenum and a cystic lesion (27 × 19 mm) contiguous with the duodenum, with an accumulation of fluid. An esophagogastroduodenoscopy showed the significantly stenotic duodenum, which prevented passage of the endoscope and evaluation of the main lesion. Based on these findings, duodenal ulcer perforation and concomitant abscess formation were suspected. Two days after admission, he had massive hematochezia with bloody drainage from the nasogastric tube.
Diagnoses:
Emergency angiography revealed duodenal ulcer bleeding from the gastroduodenal artery and the branch artery of the inferior pancreaticoduodenal artery and middle colic artery (MCA).
Interventions:
The patient was treated with transcatheter arterial embolization (TAE) of the gastroduodenal artery, the branch vessel of the inferior pancreaticoduodenal artery, and the main trunk of the MCA.
Outcomes:
Hemostasis was achieved with TAE. The patient recovered uneventfully and undergone a gastro-jejunal bypass surgery for the duodenal stenosis 2 weeks after TAE. He was discharged without any abnormal complaints on postoperative day 12.
Lessons:
We have experienced a rare case of duodenal ulcer bleeding from a branch of the MCA. In patients with refractory upper gastrointestinal bleeding, careful evaluation of bleeding sites is recommended considering unexpected culprit vessels.
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