Acute coil migration in upper gastrointestinal bleeding

A 63-year-old man presented to the hospital due to one-day history of hematemesis, with a history of cholangiocarcinoma receiving surgical resection and chemotherapy 3 years ago. The blood pressure was 61/37 mmHg, with hemoglobin level of 58 g/L. Emergency gastroscopy failed due to limited vision. Computer tomography angiography demonstrated extravasation of the contrast in the duodenum (Figure 1A), without any foreign body shadow. Digital angiography confirmed the branch of the gastroduodenal artery as the victim vessel, with pseudoaneurysm formation (Figure 1B). Transcatheter embolization with coils was performed (Figure 1C). The general condition improved but hemoglobin level continued to decrease. Repeated gastroscopy revealed a deep ulcer in the duodenal bulb with metallic, wire-like structures protruding into the lumen and blood oozing (Figure 1D). Ectopic presence of the endovascular coil was highly suspected, which was proved by subsequent surgery for successful hemostasis through resection of the distal stomach and the duodenal bulb. No carcinoma recurrence was found. This is the first report of acute coil migration as a rare complication in endovascular embolization for gastrointestinal bleeding (1,2). In this case, the pseudoaneurysm was situated at the artery’s terminus and close to the intestinal mucosa, leading to the coil penetration and migration.

Figure 1 Radiology and endoscopy in acute upper gastrointestinal bleeding. (A) Computer tomography angiography found the contrast extravasation (red arrow). (B) Digital angiography confirmed extravasation with pseudoaneurysm formation (red arrow). (C) Endovascular coils were successfully placed. (D) Gastroscopic examination found a deep and large ulcer with metallic structures protruding into the lumen.

Acknowledgments

The authors would like to thank Dr. Yabing Wang and Dr. Tao Wang for their invaluable advice in the preparation of this manuscript.

Funding: This study was funded by the National Natural Science Foundation of China (No. 32170788), National High Level Hospital Clinical Research Funding (No. 2022-PUMCH-B-023), and Beijing Natural Science Foundation (No. 7232123).

Footnote

Provenance and Peer Review: This article was a standard submission to the journal. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-24-538/coif). The authors have no conflicts of interest to declare.

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References

1. Abdalkader M, Piotin M, Chen M, et al. Coil migration during or after endovascular coiling of cerebral aneurysms. J Neurointerv Surg 2020;12:505-11. [Crossref] [PubMed]
2. Riley L, Machuca T, Alnuaimat H, et al. Migrated Endovascular Coil. An Unwelcome Guest. Am J Respir Crit Care Med 2019;200:384-5. [Crossref] [PubMed]