A case of ruptured right gastroepiploic aneurysm treated by transcatheter arterial embolization avoiding emergency surgery

Non-aneurysmal Gastroepiploic Arterial Hemorrhage With Median Arcuate Ligament Syndrome

Spontaneous non-aneurysmal gastroepiploic arterial hemorrhage is a rare occurrence, and its association with celiac axis compression syndrome (CACS), also referred to as median arcuate ligament syndrome (MALS), is even more uncommon. Furthermore, nontraumatic intraperitoneal hemorrhage due to defecation strain is also rare. This study reports an extremely rare case of non-aneurysmal gastroepiploic arterial hemorrhage with CACS/MALS after defecation strain. A 24-year-old man presented with a sudden upper abdominal pain on the left side after defecation. The patient was diagnosed with bleeding from the gastroepiploic artery and CACS/MALS using contrast-enhanced computed tomography. The patient underwent urgent laparotomy, and subsequent pathogenic examination revealed no aneurysm. This was an atypical case of intraperitoneal hemorrhage with CACS/MALS, and hemorrhage may have occurred due to a combination of vascular fragility, elevated arterial blood pressure, and hemostatic disorder.

Efficacy and safety of transcatheter arterial embolization of omental artery aneurysm: A single-center experience

BACKGROUND

Omental artery aneurysm (OAA) is an extremely rare visceral artery aneurysm. Ruptured OAAs are associated with a high mortality rate. Transcatheter arterial embolization (TAE) has been used to treat OAA in recent years. However, the risk of omental ischemia due to TAE remains unclear. Therefore, this study aimed to investigate the efficacy and safety of TAE of OAA as a first-line treatment.

METHODS

Fifteen patients with true aneurysms or pseudoaneurysms who underwent OAA-TAE between 1 April 2010 and 31 December 2022 were included in this study. The technical and clinical outcomes, the incidence of omental infarction after TAE as a major complication, OAA-TAE techniques, radiological findings on computed tomography angiography and angiogram, and patient characteristics were evaluated.

RESULTS

Fifteen patients (nine men, six women; age, 69.8 ± 18.59 years) underwent TAE of OAAs (mean aneurysm size of 9.30 ± 6.10 mm) located in the right gastroepiploic (n = 9), left gastroepiploic (n = 1), and epiploic (n = 5) arteries. All patients with ruptured (n = 6) and unruptured (n = 9) OAA successfully underwent TAEs using coils, n-butyl-2-cyanoacrylate, or gelatin sponges. Hepatic artery thrombosis and coil migration were observed during the procedure; however, these adverse events were manageable. Transfusion of red blood cell units (4.66 ± 1.63 units) was required only in cases with ruptured OAAs after TAE. Additional surgery or TAE due to rupture or rerupture of OAA and omental infarction was not required during the postoperative and follow-up periods.

CONCLUSION

The OAA-TAE can effectively treat ruptured and unruptured OAAs, and the risk of omental infarction after OAA-TAE may not be high.

Spontaneous rupture of a left omental artery aneurysm treated by transcatheter arterial embolization: A case report

Background

Omental artery aneurysms are extremely rare. Their rupture is related to high mortality and often treated by open surgery. We describe a case of a spontaneous rupture of a left omental artery aneurysm (OAA) that was successfully treated by transcatheter arterial embolization (TAE).

Case presentation

A 68-year-old man presented with acute abdominal pain. On examination, he was hypotensive and tachycardic with a blood pressure of 90/50 mm Hg. He had diffuse abdominal distension and tenderness.

An abdominal enhanced computed tomography scan (CT) showed a rupture of the left OAA responsible for moderate hemoperitoneum. We performed a successful TAE.

Conclusion

Ruptured OAA causes high mortality. OAA represents the rarest form of splanchnic artery aneurysms. Interventional radiology permits to avoid unnecessary surgery.

TAE is a safe procedure to control ruptured OAA. We highlight the importance of a rapid embolization if the patient is hemodynamically stable.

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Omental artery aneurysms (OAA) are extremely rare.

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Ruptured OAA causes high mortality.

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Transcatheter arterial embolization is a safe procedure to control ruptured OAA.

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In case of failure, surgical treatment should be performed timely.

Safety and efficacy of emergency transarterial embolization for mesenteric bleeding

Background

Patients with spontaneous or traumatic active mesenteric bleeding cannot be treated endoscopically. Transarterial embolization can serve as a potential alternative to emergency surgery. Literature on transarterial embolization for mesenteric bleeding remains very scarce. The objective of this study was to evaluate the safety and efficacy of transarterial embolization for mesenteric bleeding. We reviewed all consecutive patients admitted for mesenteric bleeding to the interventional radiology department, in a tertiary center, between January 2010 and March 2021. Mesenteric bleeding was defined as mesenteric hematoma and contrast extravasation and/or pseudoaneurysm visible on pre-operative CT scan. We evaluated technical success, clinical success, and complications.

Results

Among the 17 patients admitted to the interventional department for mesenteric bleeding, 15 presented with active mesenteric bleeding requiring transarterial embolization with five patients with hemodynamic instability. Mean age was 67 ± 14 years, including 12 (70.6%) males. Technical success was achieved in 14/15 (93.3%) patients. One patient with technical failure was treated by percutaneous embolization with NBCA-Lipiodol mixture. Three patients (20%) had early rebleeding: two were treated by successful repeat embolization and one by surgery. One patient (6.7%) had early death within 30 days and two patients (13.3%) had late death after 30 days. Mean length of hospitalization was 12.8 ± 7 days. There were no transarterial embolization-related ischemic complications.

Conclusion

Transarterial embolization is a safe and effective technique for treating mesenteric bleeding even in patients with hemodynamic instability. Transarterial embolization doesn’t close the door to surgery and could be proposed as first intention in case of mesenteric bleeding.