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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Left inferior phrenic arterial malformation mimicking gastric varices: A case report and review of literature
Han Wang, Yi-Qing Tan, Ping Han, An-Hui Xu, Han-Lin Mu, Zhe Zhu, Li Ma, Mei Liu, Hua-Ping Xie
Han Wang, Ping Han, Mei Liu, Hua-Ping Xie, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Yi-Qing Tan, Department of Radiology, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan University, Wuhan 430063, Hubei Province, China
An-Hui Xu, Han-Lin Mu, Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Zhe Zhu, Department of Pathology and Cell Biology, Columbia University Irving medical center, New York-Presbyterian Hospital, New York, NY 10065, United States
Li Ma, Department of Gastroenterology, Jianli People's Hospital, Jianli 433300, Hubei Province, China
Author contributions: Xie HP was responsible for the conception of the paper, execution of the endoscopic procedures, and review of the manuscript; Wang H collected the data of the patient and wrote the manuscript; Tan YQ performed the transcatheter arterial embolization; Han P performed the emergency gastrointestinal endoscopy (GIE); Mu HL contributed to the collection and analysis of computed tomography venography (CTV) images; Xu AH helped analyze the images of CTV venography and digital subtraction angiography; Liu M helped collect the previous GIE images before the patient’s admission to our hospital; Zhu Z, Ma L, and Xie HP reviewed the manuscript.
Supported by National Natural Science Foundation of China (General Program), No. 82200588; Hubei Provincial Natural Science Foundation of China, No. 2024AFB829.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare no competing interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hua-Ping Xie, MD, PhD, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, Hubei Province, China.
hpxie@tjh.tjmu.edu.cn
Received: May 28, 2024
Revised: August 8, 2024
Accepted: August 16, 2024
Published online: September 27, 2024
Processing time: 113 Days and 4.2 Hours
BACKGROUND
Gastric submucosal arterial dilation resulting from splenic artery occlusion represents an exceedingly rare etiology of acute upper gastrointestinal bleeding (UGIB). Although endoscopy is a widely utilized diagnostic and therapeutic modality for gastrointestinal bleeding, it has limitations in detecting arterial abnormalities.
CASE SUMMARY
This report presents a rare case of massive UGIB in a 57-year-old male with a tortuous left inferior phrenic artery accompanied by splenic artery occlusion. “Gastric varices” was identified during the patient's endoscopy one year before hemorrhage. Despite initial hemostasis by endoscopic clipping, the patient experienced massive rebleeding after one month, requiring intervention with transcatheter arterial embolization (TAE) to achieve hemostasis.
CONCLUSION
This is the first case to report UGIB due to a tortuous left inferior phrenic artery. This case highlights the limitations of endoscopy in identifying arterial abnormalities and emphasizes the potential of TAE as a viable alternative for the management of arterial bleeding in the gastrointestinal tract.
Core Tip: Endoscopy has become a widely used diagnostic and therapeutic tool for gastrointestinal bleeding, effectively screening for gastric varices and achieving hemostasis. However, arteries can mimic varices, and their ruptures require multidisciplinary discussion and alternative therapeutic options. Gastric submucosal arterial dilation due to splenic artery occlusion constitutes an exceptionally rare cause of acute upper gastrointestinal bleeding (UGIB). This is the first documented instance of UGIB originating from the left inferior phrenic artery. The study provides valuable insights into the clinical diagnosis and management of this rare and challenging condition.
