PMC4235499_01
Endoscopic examinations.. Notes: Gastroscopy showed multiple superficial mucosal lesions of duodenum and diffuse mucosal bleeding (A and B), and colonoscopy indicated active oozing of blood from ileocecal junction (C and D).
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Upper and lower endoscopies were performed, which revealed multiple superficial mucosal lesions of the duodenum and active oozing of blood from the ileocecal junction (Figure 1), and the biopsy specimen revealed lymphocytic duodenitis, which was consistent with GVHD.
Mesenteric arterial angiography.. Notes: Initial angiography (A) showed a hemorrhage spot in the initial branch of the superior mesenteric artery (indicated by arrow). Selective arterial embolization with gelatin sponge was performed and final angiography (B) demonstrated no signs of arterial bleeding (indicated by arrow).
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Then, the catheter was guided into the superior mesenteric artery at the initial segment of the pancreaticoduodenal artery, where digital subtraction angiography (DSA) showed obvious signs of contrast extravasation, which was confirmed as the bleeding site (Figure 2A). Subsequently, a further angiography was performed to confirm the occlusion of the bleeding branches (Figure 2B).