Hemorrhagic gastric ulcer in which intra-aortic balloon occlusion was useful for improving endoscopic visibility and hemostasis

Abstract

A 73-year-old man with melena was transferred to our emergency room. His hemodynamic status was stable and he had abdominal pain without peritoneal signs. He was anemic (hemoglobin, 5.3 mg/dL). Contrast-enhanced abdominal computed tomography showed focal discontinuity of the mucosal hyperenhancement in the stomach and the possibility of intra-abdominal free air. After consultation with the surgeon, conservative treatment without endoscopy was administered. On the 10th day, the patient suddenly went into cardiac arrest due to hemorrhagic shock. After resuscitation, intra-aortic balloon occlusion (IABO) was performed and emergency endoscopy revealed active spurting from a gastric ulcer. Inflating the IABO balloon not only controlled his blood pressure but also improved endoscopic visibility, and hemostasis was achieved. After the balloon was deflated, his blood pressure remained unstable, although active bleeding was not found by endoscopy. Transcatheter arterial embolization of a branch of the left gastric artery was performed, and his hemodynamic status became stable.

Inflating the balloon cephalad to the celiac artery reduced hemorrhage. IABO is effective for improving not only hemodynamics but also endoscopic visibility in patients with gastrointestinal bleeding.