Recurrent Walled-Off Necrosis Following Embolization with N-Butyl-2-Cyanoacrylate in a Patient with Upper Gastrointestinal Tract Bleeding

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A 60-year-old man with a history of rheumatoid arthritis experienced bloody stool and presented in a state of shock. Emergency endoscopy showed upper gastrointestinal bleeding from a duodenal ulcer. Endoscopic hemostasis was attempted but failed. Gastroduodenal angiography revealed an extravasation from a duodenal branch of the anterior superior pancreaticoduodenal artery (ASPDA). Hemostasis was achieved by subsequent selective transarterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA) performed via the duodenal branch. Although no recurrent bleeding was observed, walled-off necrosis (WON) developed twice at 1 and 8 months after TAE due to localized necrotizing pancreatitis. WON is a rare but potentially serious complication of TAE with NBCA from a branch of the ASPDA.