Abstract
An 82-year-old man with a history of right colectomy, right nephrectomy, and total gastrectomy plus cholecystectomy presented to our hospital because of vomiting. Since diffuse ileus seen on abdominal computed tomography (CT) did not improve with long tube insertion, adhesionectomy was performed two days after admission. On the ninth day after surgery, he developed sudden hemorrhagic shock with huge melena. Upper endoscopy and abdominal contrast-enhanced CT could not demonstrate any apparent bleeding sites. Following temporary recovery of vital signs, he relapsed into shock. A careful re-evaluation of the CT images indicated duodenal diverticular hemorrhage, which was confirmed by emergent angiography. Transcatheter arterial embolization (TAE) of the posterior-superior pancreaticoduodenal artery (PSPDA) with gelatin particles and microcoils was performed. Additional TAE to re-bleeding from the PSPDA with microcoils and another TAE to the gastroduodenal artery with NBCA (N-butyl-2-cyanoacrylate) produced complete hemostasis. His subsequent course was uneventful.
