Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2021; 9(33): 10315-10322
Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10315
Duodenal ulcer caused by coil wiggle after digital subtraction angiography-guided embolization: A case report
Sheng Xu, Shou-Xing Yang, Zhan-Xiong Xue, Chang-Long Xu, Zhen-Zhai Cai, Chang-Zhao Xu
Sheng Xu, Shou-Xing Yang, Zhan-Xiong Xue, Chang-Long Xu, Zhen-Zhai Cai, Chang-Zhao Xu, Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Author contributions: Xu S and Xu CZ drafted the manuscript and reviewed the literature; Yang SX and Xue ZX collected the patient’s clinical information and revised the manuscript; Xu CL and Cai ZZ analyzed and interpreted the imaging findings; all authors confirmed and approved the final manuscript.
Informed consent statement: Informed consent for publication of this case report has been obtained from the patients. The patient’s information was kept strictly confidential.
Conflict-of-interest statement: All authors declare that they have no conflict of 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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang-Zhao Xu, MSc, Doctor, Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 Western Xueyuan Road, Wenzhou 325000, Zhejiang Province, China. xuchangzhaofey@163.com
Received: July 4, 2021
Peer-review started: July 4, 2021
First decision: July 26, 2021
Revised: August 8, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 26, 2021
Processing time: 141 Days and 2.4 Hours
Abstract
BACKGROUND

Acute gastrointestinal bleeding (GIB) is a life-threatening medical emergency with high morbidity and mortality. Transcatheter embolization with endovascular coils under digital subtraction angiography guidance is a common and effective method for the treatment of GIB with high technical success rates. Duodenal ulcers caused by coils wiggled from the branch of the gastroduodenal artery, which is a rare complication, have not previously been reported in a patient with right intrathoracic stomach.

CASE SUMMARY

A 62-year-old man had undergone thoracoscopy-assisted radical resection of esophageal cancer and gastroesophageal anastomosis 3 years ago, resulting in right intrathoracic stomach. He was admitted to the hospital 15 mo ago for dizziness and suffered acute GIB during his stay. Interventional surgery was urgently performed to embolize the branch of the gastroduodenal artery with endovascular coils. After 15 mo, the patient was re-admitted with a chief complaint of melena for 2 d, esophagogastroduodenoscopy and abdominal computed tomography revealed that some endovascular coils had migrated into the duodenal bulb, leading to a deep ulcer. Bleeding was controlled after conservative treatment. Seven months later, duodenal balloon dilatation was performed to relieve the stenosis after the removal of a few coils, and the patient was safely discharged with only one coil retained in the duodenum due to difficulties in complete removal and risk of bleeding. Mild melena recurred once during the long-term follow-up.

CONCLUSION

Although rare, coil wiggle after interventional therapy requires careful attention, effective precautionary measures, and more secure alternative treatment methods.

Keywords: Digital subtraction angiography; Endoscopy; Esophageal neoplasms; Gastrointestinal hemorrhage; Duodenal ulcer; Case report

Core Tip: Acute gastrointestinal bleeding (GIB) is a life-threatening medical emergency with high mortality. Transcatheter embolization under digital subtraction angiography guidance is a common treatment for GIB. Herein, we report a rare case of duodenal ulcer due to coil wiggle after digital subtraction angiography-guided embolization in a patient with acute GIB who had an intrathoracic stomach due to radical resection of esophageal cancer. This case highlights that coil displacement should be considered in patients with recurrent bleeding or new gastrointestinal ulcers after interventional treatment.