Presentation
Epigastric pain. Hematemesis for a few days.
Patient Data
On the arterial and portal venous phase images there is a 1 cm region of vivid enhancement in the first part of duodenum, that was not present on the non-contrast images. This region receives supply from the gastroduodenal artery. No intraluminal contrast extravasation is seen elsewhere in the bowel.
Gallstones incidentally noted. The liver, spleen, pancreas and right kidney are unremarkable. The left kidney is mildly atrophic with regions of cortical scarring. A small left and tiny right pleural effusion is noted.
Conclusion:
The site of active hemorrhage is localized to the proximal duodenum.
Foci of active bleeding via branches of the GDA. No further site of active bleeding identified.
Using microcatheter the proximal side of the bleeder artery was coil embolized using: 3 x HILAL 2.0 mm coils from Cook with complete exclusion. No further complications identified.
Case Discussion
Endoscopy has a high sensitivity and specificity for diagnosis gastrointestinal bleeding. However, CT angiography is becoming more common in assessing gastrointestinal bleeding because the success rate of angio-embolization is markedly increased with a positive CTA.
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