Transcatheter Embolization of Extensive Left Gastric Artery Collaterals Presenting With Massive Upper Gastrointestinal Bleed

Abstract

We report a case of extensive left gastric artery collaterals that were formed in the region of gastric fundus due to splenic artery occlusion and resulted in massive hematemesis. These collaterals were thought to be portosystemic collaterals related to portal hypertension during upper endoscopy study and single-phase venous computed tomography studies. The collaterals were treated by transcatheter endovascular coil embolization. Our case highlights the importance of recognizing and differentiating left gastric artery collaterals from gastric venous varices as a cause of hematemesis since the treatment approach for each condition is totally different. It also introduces the feasibility of percutaneous left gastric artery embolization as a treatment for this condition, without the need for surgical splenectomy and partial gastrectomy which have a higher mortality and morbidity.

Massive bleeding from gastric submucosal arterial collaterals secondary to splenic artery thrombosis: A case report

“…No procedure-related major adverse events were observed[ 23 ]. Few years later, another case successfully managed in a very similar manner was described[ 24 ]. Conversely, Al-Balas et al [ 25 ] recently reported a case of bleeding GSAC initially managed via TEA and subsequently requiring emergency laparotomy with ligation of a bleeding gastric vessel and splenectomy due to severe rebleeding occurrence[ 25 ].…”