PMC6350135_01
(a) Abdominal computed tomography (CT) scan, arterial phase. The arrow
indicates the left gastric artery. The arrowheads show contrast medium
extravasations. (b) Abdominal CT scan, venous phase. The arrowheads show
extravasations spreading to the peri-stomach, left subphrenic space, and
peri-hepatic space. (c) Three-dimensional volume-rendered CT angiogram.
Label A represents the left gastric artery, label B represents the right
gastroepiploic artery, and label C represents the right gastric artery. The
arrowheads show contrast medium extravasations.
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Computed tomography (CT) was performed, and based on CT findings of massive intra-abdominal hemorrhage accompanied by arterial extravasation from the peri-pyloric portion of stomach, we judged that it was possible to achieve hemostasis by IVR (Figure 1(a)-(c)); the patient was transferred to the emergency department angiography suite (AS).
(a) An angiogram of the celiac artery. Label A represents the left gastric
artery, label B represents the right gastroepiploic artery, and label C
represents the right gastric artery. The arrowheads show contrast medium
extravasations. (b) An angiogram of the common hepatic artery. Label C
represents the right gastric artery. The arrowhead shows contrast medium
extravasation. The left gastric artery and right gastroepiploic artery were
occluded using microcoils. (c) Post-transarterial embolization. Label A
represents the left gastric artery, label B represents the right
gastroepiploic artery, and label C represents the right gastric artery.
These arteries were occluded using gelatin sponge and microcoils.
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Celiac angiography (Figure 2(a)) was performed using a 4F Shepherd hook-type catheter (Terumo, Japan). The microcatheter was advanced into the right gastric artery via the left hepatic artery and into the right gastroepiploic artery via the gastroduodenal artery, and super-selective embolization was achieved by placing 0.018'' microcoils (HILAL; Cook Medical) and gelatin sponge, respectively (Figure 2(b) and (c)).
The upper gastrointestinal endoscopy. Submucosal hematoma and ulcerative
change in the pyloric region were observed.
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After 5 days, we performed upper gastrointestinal endoscopy; submucosal hematoma and ulcerative change in the pyloric region were observed (Figure 3).