A Case of a 5-Year-Old Boy Using Endoscopic Clipping, Transarterial Embolization (TAE) and Laparotomy for the Treatment of Gastrointestinal Bleeding Due to the Rupture of a Pseudoaneurysm of Gastroduodenal Artery

DOI Web Site 1 Citations 26 References
  • Hotta Ryo
    Departments of Surgery, Keio University School of Medicine
  • Fuchimoto Yasushi
    Departments of Surgery, Keio University School of Medicine
  • Okamura Jun
    Departments of Surgery, Keio University School of Medicine
  • Yamada Yohei
    Departments of Surgery, Keio University School of Medicine
  • Nakao Shioko
    Departments of Surgery, Keio University School of Medicine
  • Komori Koji
    Departments of Surgery, Keio University School of Medicine
  • Hoshino Ken
    Departments of Surgery, Keio University School of Medicine
  • Morikawa Yasuhide
    Departments of Surgery, Keio University School of Medicine
  • Hashimoto Subaru
    Departments of Radiology, Keio University School of Medicine
  • Mukai Makio
    Departments of Division of Diagnostic Pathology, Keio University School of Medicine

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Other Title
  • 胃十二指腸動脈仮性動脈瘤出血に対して,内視鏡的クリップ術,コイル塞栓術,開腹術により救命し得た小児の1例
  • 症例報告 胃十二指腸動脈仮性動脈瘤出血に対して,内視鏡的クリップ術,コイル塞栓術,開腹術により救命し得た小児の1例
  • ショウレイ ホウコク イ ジュウニシチョウ ドウミャク カセイ ドウミャクリュウ シュッケツ ニ タイシテ ナイシキョウテキ クリップジュツ コイル ソクセンジュツ カイフクジュツ ニ ヨリ キュウメイシエタ ショウニ ノ 1レイ

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Abstract

A 5-year-old boy was transferred to our hospital in order to have tracheostomy for the exacerbation of respiratory failure with spinal muscular atrophy, type II. Two days after hospitalization, the patient underwent emergency gastrointestinal fiberscopy for his massive hematemesis. Endoscopic clipping was performed to control bleeding from a duodenal ulcer. After the temporary hemostasis was obtained, 3D CT demonstrated a small round enhancement on the gastroduodenal artery (GDA) compatible with the pseudoaneurysm of GDA. After the angiography comfirmed the location and the size of the pseudoaneurysm, transarterial embolization (TAE) was achieved using some metallic coils. After the TAE, he experienced two laparotomies for rebleeding; however, he recovered eventually. Massive hemorrhage from gastrointestinal tract is a critical situation associated with mortality in some cases. It is often difficult to identify the source of bleeding in children who usually have various underlying causes. In our case, interventional radiology (IVR) was very useful to identify the cause of bleeding. The rupture of a pseudoaneurysm of the visceral artery could be a good indication for transarterial embolization (TAE) even in children. Care should be taken to introduce this modality and a back-up operative procedure should be prepared in case of rebleeding after TAE.

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