P0894 - Migrated Endovascular Coil Leading to Life-Threatening Duodenal Ulcer Bleed Managed Endoscopically

The patient is a 65-year-old female who presented with frank hematemesis with hematochezia found to be in hemorrhagic shock upon arrival to the ER. Prompt resuscitation with intravenous fluids, transfusion of blood products and pantoprazole bolus was administered. The patient has a past medical history significant for an upper GI bleed due to a duodenal ulcer one year prior to admission which was managed with transarterial coil embolization by Interventional Radiology (IR). Patient denied any frequent NSAID use or any antithrombotic medications. Emergent EGD was performed which revealed a large adherent clot in the duodenal sweep with coil-like metallic foreign body encapsulated in the clot. IR consultation deemed the patient not to be a candidate for further additional endovascular embolization and General surgery felt repeat EGD with control of bleeding should be attempted prior to consideration of surgical intervention. Patient underwent repeat EGD by the Interventional GI team where again the previously noted platinum vascular coils placed were seen protruding from the duodenal ulcer bed. Due to concern that the migrated vascular coils was the cause of bleeding as well as the non-healing duodenal ulcer, the vascular coils were removed endoscopically using hot biopsy forceps and a snare. After retrieval of the migrated coils we then performed control of bleeding using injection of 1:10,000 epinephrine followed by bipolar cautery using 10Fr gold probe. There was no evidence of further bleeding and repeat EGD performed 2 weeks later revealed a healed duodenal sweep ulcer.

This case adds to the current literature of this rare phenomena of vascular coil migration leading to a life threatening GI bleeding which was successfully managed with endoscopic interventions.