Abdullah S. Shaikh, MD1, Michelle Baliss, DO2, Ahmed Chatila, MD3, Hamza Abdulla, MD2, Sreeram Parupudi, MD, FACG3
1University of Texas Medical Branch, Houston, TX; 2The University of Texas Medical Branch, Galveston, TX; 3University of Texas Medical Branch, Galveston, TX
Introduction: Antral gastric ulcers are typically managed through endoscopic therapy, proton-pump inhibitors, and treating any underlying cause such as Helicobacter pylori. However, in the presence of multiple, deep, continuously bleeding ulcers, partial gastrectomy is a mainstay of treatment. We present a case of a patient who was found to have diffuse, deep antral and pyloric ulcers and was managed through solely interventional radiology embolization.
Case Description/Methods: A 59 year old male patient with multiple bouts of alcoholic pancreatitis, hypertension, and chronic obstructive pulmonary disease who presented with anemia but no signs of overt GI bleeding. Patient's risk factors included NSAID use. However, CT A/P showed active bleeding with extravasation into the stomach with subsequent respiratory failure led to intubation and ICU admission. EGD showing diffuse, partially obstructing, deep antral and pyloric ulcers covering the entire antrum and pylorus not amenable to endoscopic intervention with recommendation to possibly pursue surgical intervention. Arteriograms of the celiac trunk, SMA, left gastric artery, splenic artery, common hepatic artery, and gastroduodenal artery demonstrated no active bleeding. Surgery was consulted and recommended no immediate surgical intervention, opting for interventional radiology to preform embolization if patient continues to bleed. As the patient continued to bleed, the decision was made to embolize the gastroduodenal artery. The patient did well post-procedure with stable hemoglobin with plans to follow up outpatient to determine the cause of the diffuse ulcerations.
Discussion: Diffuse, bleeding antral gastric ulcers are a consideration for antrectomy or partial gastrectomy if the lesions are not amenable to endoscopic intervention. However, in the case of our patient, interventional radiology embolized the gastroduodenal arterial, despite no active bleeding on CT angiography. The empiric embolization successfully treated the source of bleeding without need for surgical intervention. Our case helps emphasize that Interventional Radiology embolization of the gastroduodenal artery may be considered in patients with multiple actively bleeding, antral gastric ulcers who are not surgical candidates despite the lack of bleeding on CT angiography.
Citation: Abdullah S. Shaikh, MD; Michelle Baliss, DO; Ahmed Chatila, MD; Hamza Abdulla, MD; Sreeram Parupudi, MD, FACG. P0434 - A CASE OF DIFFUSE ANTRAL AND PYLORIC ULCERS. Program No. P0434. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.