Case study

73-year-old male patient with a PMH significant for CKD, HTN, and lumbar spine surgery who presents with acute GI bleeding. Endoscopy demonstrated one non-bleeding ulcer in the duodenal bulb and a second slowly bleeding ulcer in the second portion of the duodenum that was treated with an epinephrine injection and placement of a hemostatic clip due to continued bleeding, endoscopy was repeated, demonstrating spurting blood from the previously treated ulcer which was treated again with an epinephrine injection and fulguration. Angiography was then performed.

Arterial access was gained via the right common femoral artery. A Sos-2 catheter was positioned at the origin of the celiac axis and an angiogram was performed, which failed to demonstrate any abnormalities of the gastroduodenal artery (GDA). This was confirmed after selective catheterization and angiography of the GDA with a Renegade™ HI-FLO™ Microcatheter. Prophylactic embolization of the GDA was then performed with two 4 mm X 15 cm Embold™ Detachable Coils followed by administration of 0.5 mL of Obsidio Embolic (purple arrow). Follow-up angiography demonstrated successful occlusion of the GDA.

Following embolization, he received 1u of additional PRBCs and his hemoglobin subsequently remained stable. He was discharged with a hemoglobin of 8.7 g/dL.