Colonoscopic Removal of Arterial Embolization Coils Migrating into the Gastrointestinal Lumen: A Case Report

Introduction Splenic artery pseudoaneurysms (SAP) are rare vascular injuries, mainly associated with pancreatitis. Management is generally initially attempted with transcatheter embolization. While success rates for embolization exceed 90%, complications may arise, even months after embolization.

Case Report A 68-year-old male who had previously undergone laparoscopic cholecystectomy, complicated by an abscess near the pancreatic head and bacteremia, was transferred to our institution following an episode of hematochezia. A computed tomography scan upon arrival revealed inflammation of pancreatic head, a pancreatic head pseudocyst, and splenic artery pseudoaneurysm in a branch of the splenic artery (SAP).

The SAP was successfully occluded via transcatheter coil embolization of the feeding artery and packing of the pseudoaneurysm sack. One month later, a computed tomography showed unraveled coil present in the descending colon suggesting pseudoarterio-colonic fistula. Part of this passed, but repeated imaging demonstrated additional coils outside the psueodocaneurysm sack in the retroperitoneum and in the colon. Based on a multidisciplinary discussion, a colonoscopy was performed to remove the unraveled coil from the colonic lumen and subsequent closure of fistula orifice with an over the scope clip. This was performed without complication. A computed tomography angiogram obtained immediately after the procedure demonstrated presence of the endoscopic clip and a stably thrombosed SAP. The patient was discharged the following day.

Learning Points This case report showed a rare erosion of an embolization coil into the gastrointestinal lumen, successful colonoscopic removal of embolization coils, and concurrent closure of pseudoarterio-colonic fistula. Minimally invasive endoscopic techniques spared surgical intervention.