Presentation
Patient with a history of alcohol abuse and cirrhosis with ascites, found to have spontaneous bacterial peritonitis and large volume hematochezia. Recurrent bleeding of esophageal varicies prompted CTA and IR consultation.
Patient Data
DSA obtained from superselective catheterization of a branch of the inferior pancreaticoduodenal artery demontrating the bleeding into the main pancreatic duct, extending into the duodenum.
Superselective catheterization better demonstrating the bleeding into the main pancreatic duct, extending into the duodenum. Embolization was performed with gelatin sponge slurry.
Last image shows postembolization of the superior mesenteric artery. Arteriogram demonstrates pruning of the pancreatic vasculature and no active bleeding.
Case Discussion
The bleeding subsided after embolization but the patient unfortunately expired two months later due to progressive deterioration in the setting of decompensated cirrhosis.