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Coil Erosion Into the Duodenum Following Arterial Embolization

Palagiri, Asma Nazneen MBBS1; Hamo, Falak MD2; Samo, Salih MD, MSc, FACP3; Chawla, Saurabh MD, FACG3

doi: 10.14309/crj.0000000000000195
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1Osmania Medical College, Hyderabad, Telangana, India

2Al Andalus University for Medical Sciences, Al-Qadmus, Syria

3Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA

Correspondence: Salih Samo, MD, MSc, FACP, Division of Digestive Diseases, Emory University School of Medicine, 615 Michael St, Suite 201, Atlanta, GA (ssamo@emory.edu).

Received March 09, 2019

Received in revised form May 15, 2019

Accepted July 09, 2019

Online date: August 21, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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CASE REPORT

A 44-year-old woman presented with hematemesis and melena. Laboratory evaluation showed a hemoglobin of 3.6 g/dL, down from 9.7 g/dL 1 month prior. An esophagogastroduodenoscopy revealed a large nonbleeding ulcer with a visible vessel in the duodenal bulb (Figure 1). Cauterization of the vessel was complicated by profuse bleeding and attempts to achieve hemostasis with epinephrine injection, electrocauterization, and clip placement failed. The patient subsequently underwent angiogram, which did not reveal any active extravasation. However, empiric coil embolization of gastroduodenal, inferior pancreaticoduodenal, and right gastroepiploic arteries was performed successfully (Figure 2). Repeat esophagogastroduodenoscopy 3 days later for continued melena showed the large duodenal ulcer with the embolization coils eroding through the ulcer bed into the duodenal lumen (Figure 3).

Figure 1

Figure 1

Figure 2

Figure 2

Figure 3

Figure 3

The incidence of coil migration has been reported up to 3%.1 Coil migration may occur early after the embolization procedure if the base of the duodenal ulcer is eroding into the vessel or much later due to a local inflammatory response incited by the coil. No intervention is usually required for local migration due to the fibrosis around the migrated coil, although occasionally distant migration, ulceration, or rebleeding may occur.2–4 Distal migration of embolization coils is rare, and these patients are usually asymptomatic; hence, prophylactic removal of these coils is not advised. For symptomatic patients, given that no consensus has been established, each case should be individually addressed in a multidisciplinary fashion in collaboration with interventional radiology and surgery. Our patient was discharged 10 days after the initial presentation in stable condition. The patient remained stable on clinic visits at 2 weeks and 3 months after discharge with no evidence of gastrointestinal bleeding.

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DISCLOSURES

Author contributions: AN Palagiri and S. Samo wrote the manuscript. All authors reviewed and approved the manuscript. S. Samo is the article guarantor.

Financial disclosures: None to report.

Informed consent was obtained for this case report.

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REFERENCES

1. Leyon JJ, Littlehales T, Rangarajan B, et al. Endovascular embolization: Review of currently available embolization agents. Curr Probl Diagn Radiol. 2014;43:35–53.
2. Jaurigue MM, Snyder M, Cannon M. Recurrent upper GI bleeding secondary to coil migration in a patient with known NSAID-induced peptic ulcer disease. Gastrointest Endosc. 2014;79:1004; discussion 1005.
3. Dulskas A, Rudinskaite G, Maskelis R, et al. Duodenal ulceration following gastroduodenal artery embolization with coils. Endoscopy. 2015;47(suppl 1):E488–9.
4. Hewgley WP, Webb DL, Garrett HE Jr. Migrated embolization coil causes intestinal obstruction. J Vasc Surg Cases Innov Tech. 2018;4:8–11.
© 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.