CASE REPORT   

Journal of Radiological Review 2020 January-February;7(1):54-9

DOI: 10.23736/S2723-9284.20.00252-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English, Italian

Endovascular treatment of bleeding ulcer in a duodenal diverticulum fed by right hepatic artery

Sebastiano PIANA ¹ ✉, Giuseppe GIORDANO ², Adriano VIGLIANESI ², Ilenia A. VIZZINI ³, Domenico COMPAGNONE ⁴, Vincenzo MAGNANO SAN LIO ²

¹ Unit of Radiology, Basso Ragusa Mario Hospital, Azienda Sanitaria Provinciale n. 3 of Catania, Catania, Italy; ² Unit of Diagnostic and Interventional Radiology, Garibaldi Hospital, Catania, Italy; ³ Unit of Radiodiagnostic and Radiotherapy, Vittorio Emanuele University Polyclinic, Catania, Italy; ⁴ Unit of Medicine, Garibaldi Hospital, Catania, Italy

We report a case of anemic 79-year-old-man, who came in emergency room following episode of melena and hematemesis, in a picture of bleeding peptic ulcer. An angio-computed tomography (CT) examination was performed. A bleeding fed by right hepatic artery was found with active extravasation of iodinated contrast medium in the lumen of a duodenal diverticulum of the second portion of the duodenum. After the failure of a first endoscopic approach the patient was brought into the angiographic room. Following selective catheterization of the right hepatic artery an extravasation of contrast medium into the duodenal diverticulum lumen was found. The interventional radiologist therefore placed a coated stent at the site of the vascular lesion preserving the patency of the artery above and perfusion of the hepatic parenchyma. After interventional procedure the patient showed stable values of hemoglobinemia and had no longer further episodes of hematemesis. The angio-CT control at a distance of three days showed no further extravasation of iodinated contrast medium in the lumen of the duodenal diverticulum. Angio-CT examination allows an accurate diagnosis of the bleeding cause and allows to perform an interventional treatment tailored to the vascular lesion present, avoiding performing empirical blind embolic treatments and thus also reducing the rate of complications related to the interventional treatment itself.

KEY WORDS: Peptic ulcer hemorrhage; Endovascular procedures; Stents