Successful endovascular treatment of endoscopically unmanageable hemorrhage from a duodenal ulcer fed by a renal artery: A case report

查看全文 作　　者：Shimpei [1]Anami;Hiroki [1,2]Minamiguchi;Naoaki [3]Shibata;Takao [1]Koyama;Hirotatsu [1]Sato;Akira [1]Ikoma;Motoki [1]Nakai;Takuji [2]Yamagami;Tetsuo [1]Sonomura

机构地区：[1]Department of Radiology, Wakayama Medical University;[2]Department of Radiology, Kochi Medical School Kochi University;[3]Department of Emergency and Critical Care Medicine, Wakayama Medical University

出　　处：《World Journal of Clinical Cases》索引2018年第6卷第15期,共6页

摘　　要：A 52-year-old woman was admitted with hypovolemic shock. Emergency endoscopy revealed three hemorrhagic duodenal ulcers(all stage A1) with exposed vessels. Two ulcers were successfully treated by endoscopic clipping; however, the remaining ulcer on the posterior wall of the horizontal portion of the duodenum could not be clipped. Because her vital signs were rapidly worsening, we performed transcatheter arterial embolization(TAE) as it is less invasive than surgery. Computed tomography aortography showed that the duodenal hemorrhage was sourced from the lower branch of the right renal artery. In general, the duodenum is fed by branches from the gastroduodenal artery or superior mesenteric artery. However, this patient had three right renal arteries. The lower branch of the right renal artery at the L3 vertebral level was at the same level as the horizontal portion of the duodenum. Complete hemostasis was achieved by TAE using metallic coils and n-butyl-2-cyanoacrylate. After TAE, she recovered from the hypovolemic shock and was discharged from hospital. She has had no recurrence of the hemorrhagic duodenal ulcer for over 1 yr, and followup endoscopy showed no necrosis or stricture of the duodenum. Although she developed a small infarct of her right kidney, her renal function was satisfactory. In summary, the present case is the first reported case of hemorrhagic duodenal ulcer in which the culprit vessel was a renal artery that was successfully treated by TAE. Computed tomography aortography before TAE provides valuable information regarding the source of a duodenal hemorrhage. 关键词：TRANSCATHETER arterial EMBOLIZATION Metallic coils N-butyl-2-cyanoacrylate Renal artery Emergency radiology Case report DUODENAL ULCER

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Successful endovascular treatment of endoscopically unmanageable hemorrhage from a duodenal ulcer fed by a renal artery: A case report

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