GI Hemorrhage

Abstract

Post embolization gastric necrosis DefinitionGastric necrosis that is a direct result of embolization, and may be contributed by an overall global hypoperfusion of the stomach.Cases of extensive gastric necrosis after therapeutic transcatheter embolization of the gastric arteries (Bradley and Goldman 1976; Bookstein et al. 1974; Tadavarthy et al. 1974) have been reported with more severe outcomes associated with embolization of the left gastric artery (Brown et al. 1989). However, they are very rare, due to the extensive blood supply of the stomach.Studies have demonstrated that in order for gastric necrosis to occur, you have to ligate the right and left gastric arteries, as well as the right and left gastroepiploic arteries and 80 % of collaterals. There is a higher chance of necrosis to occur if both arteries and veins are ligated (Somervell 1945; Babkin et al. 1943). However, cases have been reported where high-dose intra-arterial vasopressin has caused necrosis (Alves et al. 1979).Diagnosis is usually delayed due to the relative rarity of the condition. The patient may have signs of peritonism, increasing nasogastric tube output, shock, and/or worsening acidosis. Imaging modalities, which may prove useful, are an erect chest radiograph or a supine abdominal radiograph, which may demonstrate subphrenic air or air in the stomach wall. This can be confirmed by contrast-enhanced CT which may demonstrate pneumoperitoneum, decreased uptake of contrast in the stomach wall, gastric pneumatosis (Abboud et al. 2006), or intra-biliary air.If gastric necrosis is suspected, then empiric physiological resuscitation must take place, this includes intravenous fluids and antibiotics, and expeditious transfer to the operating room. Operative interventions can vary from local wedge resections, but invariably require major resection.