Rezidivierende Ulcus-duodeni-Blutung: „Coil“-Migration nach transarterieller Embolisation

Zusammenfassung

Wir berichten über einen 44-jährigen Patienten mit einer oberen GI-Blutung aus einem großen(> 2 cm) peptischen Ulcus duodeni. Bei einem schweren Blutungsrezidiv war in einer Forrest-Ib-Situation die endoskopische Blutstillung ineffektiv. Als Alternative zur Operation wurde eine interventionelle Angiografie durchgeführt und dabei ein Aneurysma der A. gastroduodenalis und die A. gastroduodenalis mit 5 Coils embolisiert. Am dritten Tag nach erfolgreicher Embolisation beobachteten wir als eine seltene Komplikation die Penetration von Coilanteilen im Zentrum des Ulcus duodeni. Während der Abheilung des Ulkus gab es keinen Hinweis auf eine Rezidivblutung. In der Diskussion wird der Stellenwert der transarteriellen Embolisation beim Management der komplizierten Ulkusblutung herausgestellt.

Abstract

We present a 44 years old patient with an upper GI bleeding from a large (> 2 cm) peptic duodenal ulcer. After severe rebleeding (Forrest Ib) and failed endoscopic therapy, interventional radiology was performed. Five coiles have been successfully placed to embolize first the aneurysm of the gastroduodenal artery and secondly the artery itself. As consequence the bleeding ceased and the patient’s condition improved rapidly. Coil penetration in the centre of the duodenal ulcer occurred as a rare complication. In the follow-up no further hemorrhage has been observed. The importance of transcatheter arterial embolization as effective measure in the management of complicated peptic ulcer bleeding will be discussed.

Schlüsselwörter

Ulcus-duodeni-Blutung - Endoskopie - Angiografie - Embolisation - Chirurgie

Key words

duodenal ulcer bleeding - endoscopy - angiography - embolization - surgery

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