Endoscopic Removal of a Migrated Coil after Embolization of a Splenic Pseudoaneurysm: A Case Report

Han, Yoo Min; Lee, Jong Yeul; Choi, Il Ju; Kim, Chan Gyoo; Cho, Soo‐Jeong; Lee, Jun Ho; Kim, Hyun Beom; Choi, Ji Min

doi:10.5946/ce.2014.47.2.183

Cited by 17 publications

(26 citation statements)

References 18 publications

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“…In a pseudoaneurysm, occluding the normal portion of the artery proximally and distally instead of filling the pseudoaneurysm itself with coils has shown to decrease the incidence of migration. The use of the sandwich technique while deploying coils is shown to prevent coil migration [8].…”

Section: Discussionmentioning

confidence: 99%

“…Long-term follow-up with plain radiographs has been done to detect migration of coils in a few case reports [9]. Hot biopsy forceps was used to cut the wires and the migrated coils were successfully removed in one case report and another described using endoscopic scissors to cut the coils and extracting it in a piecemeal fashion with the help of raw-toothed forceps [8][9][10]. Bleeding is a major risk for the removal of migrated coils using the above procedures.…”

Section: Discussionmentioning

confidence: 99%

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Rare Complication of Interventional Radiology-guided Arterial Embolization of the Gastroduodenal Artery in the Setting of Acute Gastrointestinal Bleed: Migrated Coils in the Duodenum

Kudaravalli

Saleem

Pendela

et al. 2020

Cureus

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A 91-year-old male presented to the emergency room with hemodynamically significant upper gastrointestinal bleeding. The patient underwent an esophagogastroduodenoscopy (EGD), which showed frank blood in the duodenum interfering with the visualization. Hence, the patient underwent urgent interventional radiology (IR)-guided arteriogram and embolization. An EGD done 48 hours later showed a giant, non-bleeding, cratered duodenal ulcer with a visible vessel and vascular coils partially protruding into the duodenal bulb lumen. The patient had no evidence of bleeding post embolization. The patient presented three months later with abdominal pain. Computed tomography (CT) abdomen showed multiple liver abscesses. IRguided drainage of abscesses was performed, and the culture grew Streptococcus intermedius. Magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and barium enema were unremarkable. The patient was treated with a prolonged course of intravenous (IV) antibiotics and recovered without any further issues. IR guided arterial embolization can be lifesaving in cases where GI bleeding cannot be controlled endoscopically, however, it can lead to serious complications, including endovascular coil migration into the gastrointestinal (GI) lumen causing infection and rebleeding. Endovascular coil migration can occur immediately or several years later, which can result in fatal bleeding and infection. The best approach to prevent and manage migrated endovascular coils in the GI lumen remains unclear.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rare Complication of Interventional Radiology-guided Arterial Embolization of the Gastroduodenal Artery in the Setting of Acute Gastrointestinal Bleed: Migrated Coils in the Duodenum

Kudaravalli

Saleem

Pendela

et al. 2020

Cureus

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“…There are sparse data in the literature to make recommendations on management of eroded coils. Some coils pass spontaneously [ 5 ], some were removed endoscopically under fluoroscopic guidance [ 8 , 9 ] and some necessitate a partial gastrectomy with distal pancreatectomy and splenectomy [ 6 ]. Our approach to retrieve the coil was unique in two ways.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic endoscopic combined surgery for removal of migrated coil after embolization of ruptured splenic artery aneurysm

Pratap

Pokala

Vargas

et al. 2018

Journal of Surgical Case Reports

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Splenic artery aneurysm is the most common visceral arterial aneurysm. Rupture of aneurysm is a rare event but associated with a high mortality. Endovascular coil embolization of bleeding splenic artery aneurysm has emerged as a promising minimal invasive treatment and considered safer than open surgery in selected patients. Nevertheless, several complications related to coils have been reported, the rarest being coil migration and erosion. We report a case of splenic artery coil migration into the stomach and its successful removal by laparoscopic endoscopy combined surgery.

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“…Aneurysm coil migration from all sites into the gastrointestinal tract has been reported in at least twelve cases [ 25 , 26 ]. Coil migration into the CBD from the RHA has been reported in five cases (Table 1 ) [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Vascular coil erosion into hepaticojejunostomy following hepatic arterial embolisation

et al. 2015

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BackgroundRight hepatic arterial injury (RHAI) is the most common vascular injury sustained during laparoscopic cholecystectomy, occurring in up to 7% of cholecystectomies. RHAI is also the most common vascular injury associated with a bile duct injury (BDI) and is reported to occur in up to 41 – 61% of cases when routine angiography is employed following a BDI.We present an unusual case of erosion of vascular coils from a previously embolised right hepatic artery into bilio-enteric anastomoses causing biliary obstruction. This is on a background of biliary reconstruction following a major BDI.Case presentationA 37-year old man underwent a bile duct reconstruction following a major BDI (Strasberg-Bismuth E4 injury) sustained at laparoscopic cholecystectomy. He had two separate bilio-enteric anastomoses of the right and left hepatic ducts and had a modified Terblanche Roux-en-Y access limb formed.Approximately three weeks later he was admitted for significant gastrointestinal bleeding and was hypotensive and anaemic. Selective computed tomography angiography revealed a 2 x 2 centimetre right hepatic artery pseudoaneurysm, which was urgently embolised with radiological coils.Two months later he developed intermittent fevers, rigors, jaundice, and right upper quadrant pain with evidence of intrahepatic biliary dilatation on magnetic resonance cholangiopancreatography. The degree of intrahepatic biliary dilatation progressively increased on subsequent imaging over several months, suggesting stricturing of the bilio-enteric anastomoses. Several attempts to traverse these strictures with a percutaneous transhepatic approach had failed. Then, approximately ten months after the initial BDI repair, choledochoscopy through the Terblanche access limb revealed multiple radiological coils within the bilio-enteric anastomoses, which had eroded from the previously embolised right hepatic artery. A laparotomy was performed to remove the coils, take down the existing obstructed bilio-enteric anastomoses and revise this. Following this the patient recovered uneventfully.ConclusionObstructive jaundice and cholangitis secondary to erosion of angiographically placed embolisation coils is a rarely described complication. In view of the relative frequency of arterial injury and complications following major bile duct injury, we suggest that these patients be formally assessed for associated arterial injury following a major BDI.

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Endoscopic Removal of a Migrated Coil after Embolization of a Splenic Pseudoaneurysm: A Case Report

Cited by 17 publications

References 18 publications

Rare Complication of Interventional Radiology-guided Arterial Embolization of the Gastroduodenal Artery in the Setting of Acute Gastrointestinal Bleed: Migrated Coils in the Duodenum

Rare Complication of Interventional Radiology-guided Arterial Embolization of the Gastroduodenal Artery in the Setting of Acute Gastrointestinal Bleed: Migrated Coils in the Duodenum

Laparoscopic endoscopic combined surgery for removal of migrated coil after embolization of ruptured splenic artery aneurysm

Vascular coil erosion into hepaticojejunostomy following hepatic arterial embolisation

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