BACKGROUND Acute gastrointestinal bleeding(GIB)is a life-threatening medical emergency with high morbidity and mortality.Transcatheter embolization with endovascular coils under digital subtraction angiography guidanc...BACKGROUND Acute gastrointestinal bleeding(GIB)is a life-threatening medical emergency with high morbidity and mortality.Transcatheter embolization with endovascular coils under digital subtraction angiography guidance is a common and effective method for the treatment of GIB with high technical success rates.Duodenal ulcers caused by coils wiggled from the branch of the gastroduodenal artery,which is a rare complication,have not previously been reported in a patient with right intrathoracic stomach.CASE SUMMARY A 62-year-old man had undergone thoracoscopy-assisted radical resection of esophageal cancer and gastroesophageal anastomosis 3 years ago,resulting in right intrathoracic stomach.He was admitted to the hospital 15 mo ago for dizziness and suffered acute GIB during his stay.Interventional surgery was urgently performed to embolize the branch of the gastroduodenal artery with endovascular coils.After 15 mo,the patient was re-admitted with a chief complaint of melena for 2 d,esophagogastroduodenoscopy and abdominal computed tomography revealed that some endovascular coils had migrated into the duodenal bulb,leading to a deep ulcer.Bleeding was controlled after conservative treatment.Seven months later,duodenal balloon dilatation was performed to relieve the stenosis after the removal of a few coils,and the patient was safely discharged with only one coil retained in the duodenum due to difficulties in complete removal and risk of bleeding.Mild melena recurred once during the long-term follow-up.CONCLUSION Although rare,coil wiggle after interventional therapy requires careful attention,effective precautionary measures,and more secure alternative treatment methods.展开更多
目的:探讨C T门静脉成像(c o m p u t e d tomography angiography,CTA)在门脉高压合并胃底静脉曲张(gastric fundal varices)患者的分流状态的评估以及治疗方案的选择价值.方法:回顾性分析2011-01/2014-06安徽医科大学附属第一医院诊...目的:探讨C T门静脉成像(c o m p u t e d tomography angiography,CTA)在门脉高压合并胃底静脉曲张(gastric fundal varices)患者的分流状态的评估以及治疗方案的选择价值.方法:回顾性分析2011-01/2014-06安徽医科大学附属第一医院诊断门脉高压症患者40例,分别进行内镜以及CTA检查,记录内镜下分型以及CTA血供,测量门脉系统血管直径,记录分流道特点,综合评估分流道状态.相关数据进行进一步统计学分析.结果:40例患者均存在胃底静脉曲张,其中两例CTA提示胃底静脉曲张而胃镜检查未发现.CTA和内镜检查对于曲张胃底静脉的形态对照的一致性检验(Kappa=0.870),差异有统计学意义(P<0.01).GOV2型和IGV型伴胃和/或脾-肾分流的几率较大,达到60.87%.本组病例中,存在胃/脾-肾分流道的19例,门静脉直径平均为1.39 cm±0.25 cm;余无胃/脾-肾分流道形成,门静脉直径的平均值1.56 cm±0.31 cm.其中有5例分流道直径>5 mm患者选择了经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)治疗合并分流道封堵术,患者症状均得到控制.对于无分流道以及分流道直径较小患者使用组织胶治疗胃底静脉曲张,术后观察未有出现组织黏合剂栓塞情况,治疗安全有效.结论:CTA可显示胃底静脉曲张侧枝循环的类型及特点,而分流状态的评估对于该类患者治疗方案的选择以及预后评估有着重要价值.展开更多
文摘BACKGROUND Acute gastrointestinal bleeding(GIB)is a life-threatening medical emergency with high morbidity and mortality.Transcatheter embolization with endovascular coils under digital subtraction angiography guidance is a common and effective method for the treatment of GIB with high technical success rates.Duodenal ulcers caused by coils wiggled from the branch of the gastroduodenal artery,which is a rare complication,have not previously been reported in a patient with right intrathoracic stomach.CASE SUMMARY A 62-year-old man had undergone thoracoscopy-assisted radical resection of esophageal cancer and gastroesophageal anastomosis 3 years ago,resulting in right intrathoracic stomach.He was admitted to the hospital 15 mo ago for dizziness and suffered acute GIB during his stay.Interventional surgery was urgently performed to embolize the branch of the gastroduodenal artery with endovascular coils.After 15 mo,the patient was re-admitted with a chief complaint of melena for 2 d,esophagogastroduodenoscopy and abdominal computed tomography revealed that some endovascular coils had migrated into the duodenal bulb,leading to a deep ulcer.Bleeding was controlled after conservative treatment.Seven months later,duodenal balloon dilatation was performed to relieve the stenosis after the removal of a few coils,and the patient was safely discharged with only one coil retained in the duodenum due to difficulties in complete removal and risk of bleeding.Mild melena recurred once during the long-term follow-up.CONCLUSION Although rare,coil wiggle after interventional therapy requires careful attention,effective precautionary measures,and more secure alternative treatment methods.
文摘目的:探讨C T门静脉成像(c o m p u t e d tomography angiography,CTA)在门脉高压合并胃底静脉曲张(gastric fundal varices)患者的分流状态的评估以及治疗方案的选择价值.方法:回顾性分析2011-01/2014-06安徽医科大学附属第一医院诊断门脉高压症患者40例,分别进行内镜以及CTA检查,记录内镜下分型以及CTA血供,测量门脉系统血管直径,记录分流道特点,综合评估分流道状态.相关数据进行进一步统计学分析.结果:40例患者均存在胃底静脉曲张,其中两例CTA提示胃底静脉曲张而胃镜检查未发现.CTA和内镜检查对于曲张胃底静脉的形态对照的一致性检验(Kappa=0.870),差异有统计学意义(P<0.01).GOV2型和IGV型伴胃和/或脾-肾分流的几率较大,达到60.87%.本组病例中,存在胃/脾-肾分流道的19例,门静脉直径平均为1.39 cm±0.25 cm;余无胃/脾-肾分流道形成,门静脉直径的平均值1.56 cm±0.31 cm.其中有5例分流道直径>5 mm患者选择了经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)治疗合并分流道封堵术,患者症状均得到控制.对于无分流道以及分流道直径较小患者使用组织胶治疗胃底静脉曲张,术后观察未有出现组织黏合剂栓塞情况,治疗安全有效.结论:CTA可显示胃底静脉曲张侧枝循环的类型及特点,而分流状态的评估对于该类患者治疗方案的选择以及预后评估有着重要价值.
