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J Interv Gastroenterol 3:3, 113-114; July/August/September 2013; 2013 Landes Bioscience
Rare complication of variceal embolization: a novel case
Veeral M. Oza, Edward Levine, Robert Kirkpatrick IIIDepartment of Medicine, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH 43210, USA
What is new in this Letter to the Editor:
First description of a embolization coil
eroding thru a duodenal varix; Adding to the known risks of coils when used for
embolization of a varix. To date only gastric varix erosion and vascular aneurysm
erosions have been described. This adds to the existing literature as well.
A 61-year-old female with a history large metal coil was noted to be eroding
of cirrhosis secondary to Hepatitis into the duodenal lumen thru the site of
C was admitted with hematochezia and previously embolized duodenal varix (Fig.
hematemesis. She had a history of vari-
). No active bleeding was noted.
hepatic portosystemic shunt (TIPS) the gastrointestinal tract is an extremely procedure two years earlier. On arrival rare complication of variceal embolization. she was resuscitated and started on a To the best of our knowledge this is continuous infusion of esomeprazole the first report of an embolization coil and octreotide. She was admitted to the eroding through a duodenal varix. There Intensive care unit (ICU) and underwent are only 2 other case reports that report an esophagogastroduodenoscopy (EGD) coil penetration into the gastric lumen which revealed duodenal varices, but no thru a gastric varix.1,2 Coil migration and evidence of esophageal or gastric varices. penetration has been reported in other Interventional Radiology was consulted procedures such as endovascular celiac for evaluation of the patients’ TIPS. Intra-
operatively, the TIPS was revised and two penetration is likely related to inflammation prominent variceal branches were noted to and formation of a fistulous tract into the be overlying the duodenum. These were lumen.2 In our patient, there was concern
coiled to stasis using 14 Tornado 0.035 that any manipulation of this coil would
portosystemic shunt, coil migration, fis-
inch coils. Patient had no further issues worsen the bleeding and potentially cause
coils placed for embolization of varices
Three months after the initial and who present with significant bleeding,
admission, our patient returned with erosion of the coil into the lumen,
creating a porto-duodenal fistula, should
recurrent hematochezia, melena and hemoglobin of 5.9 mg/dl. An NG lavage be on the differential. Management of
revealed bloody output. Once again, the such patients should be in conjunction
with Interventional Radiology as well as
patient was resuscitated and admitted to the ICU. An emergent EGD was surgeons and appropriate consideration
performed and no esophageal varices or should be given to placement of a surgical
gastric varices were noted. Interestingly, a shunts.
Veeral M. Oza; Email: firstname.lastname@example.org
Endoscopic appearance of the previously placed coils eroding thru the
endovascular treatment of gastric varices. A Case report.
for bleeding gastric varices. J Interv Gastroenterol 2011;
1. Kupkova BF, T, Krajina A, Hulek P, Hulek P, Tacheci
Folia Gastroenterol Hepatol 2006; 4:107-11.
I, Bures J. Porto-gastric fistula due to penetration of
2. Hussain S, Ghaoui R. Porto-gastric fistula from
metallic coil into the stomach: a rare complication of
penetration of coil from gastric varix after TIPS procedure
The Harley Street Clinic Department of Radiology Outpatient Diagnostic Centre Telephone: 020 7935 7700 (Main Switchboard)Telephone: 020 7323 0365 (Nuclear Medicine and Ultrasound)Facsimile: 020 7323 0340 (Nuclear Medicine and Ultrasound)Telephone: 020 7487 3672 (Direct Line)Facsimile: 020 7486 2884Email:radiology@harleystreetclinic.HCAHealthcare.co.uk RADIOLOGY REQUEST FORM Please t
Cambridge Law Journal Trumping Bolam: a critical legal analysis of Bolitho's "gloss" Subject: Negligence. Other related subjects: Health. Personal injury Keywords: Bolam test; Causation; Clinical negligence; Patients' rights; Professional opinion *C.L.J. 609 I. INTRODUCTION THE Bolam test of breach - that classic and well-known statement of the law, with its genesis