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Clinical Journal of Gastroenterology

, Volume 12, Issue 1, pp 20–24 | Cite as

Successful treatment of esophageal bleeding due to rupture of major aortopulmonary collateral arteries by transcatheter arterial embolization

  • Takanori Ito
  • Masatoshi IshigamiEmail author
  • Yoji Ishizu
  • Teiji Kuzuya
  • Takashi Honda
  • Masaya Matsushima
  • Taichi Kato
  • Yoshiki Hirooka
Case Report
  • 61 Downloads

Abstract

Major aortopulmonary collateral arteries (MAPCAs) are unique vessels associated with hypoxia induced by congenital heart disease (CHD). Although MAPCAs are essential to supply blood to the lungs, their development and proliferation can induce life-threatening complications, such as rupture into the lung. Here, we describe a rare case of esophageal bleeding from MAPCAs in a CHD patient, which was successfully treated by transcatheter arterial embolization (TAE). A 16-year-old male with CHD experienced a hematemesis and melena after the Bentall procedure to treat valvular heart disease. Emergent esophagogastroduodenoscopy revealed spurting bleeding from the middle esophageal vessels; accordingly, endoscopic variceal ligation (EVL) was performed. However, he had a hematemesis again after 2 weeks of EVL. The arterial phase of dynamic computed tomography indicated that a MAPCA associated with CHD was the origin of bleeding. Hence, TAE of this MAPCA with a mixture of n-butyl-2-cyanoacrylate and ethiodized oil was performed to prevent re-bleeding. Color Doppler mode in endoscopic ultrasonography via the esophagus revealed mosaic-like signals in MAPCAs located in the esophageal wall. This finding was consistent with tortuous MAPCAs accompanied by turbulent blood flow. When clinicians encounter CHD patients with unexpected massive esophageal bleeding, bleeding related to MAPCAs should be considered.

Keywords

Major aortopulmonary collateral artery Congenital heart disease Esophageal bleeding Transcatheter arterial embolization 

Abbreviations

MAPCA

Major aortopulmonary collateral artery

CHD

Congenital heart disease

TAE

Transcatheter arterial embolization

EVL

Endoscopic variceal ligation

CT

Computed tomography

NBCA

n-Butyl-2-cyanoacrylate

EGD

Esophagogastroduodenoscopy

EUS

Endoscopic ultrasonography

GI

Gastrointestinal

CA

Celiac artery

SMA

Superior mesenteric artery

Notes

Compliance with ethical standards

Conflict of interest

The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

Human rights

All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent for being included in this report was obtained from family of this patient.

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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Takanori Ito
    • 1
  • Masatoshi Ishigami
    • 1
    Email author
  • Yoji Ishizu
    • 1
  • Teiji Kuzuya
    • 1
  • Takashi Honda
    • 1
  • Masaya Matsushima
    • 2
  • Taichi Kato
    • 3
  • Yoshiki Hirooka
    • 1
  1. 1.Department of Gastroenterology and HepatologyNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of RadiologyNagoya University Graduate School of MedicineNagoyaJapan
  3. 3.Department of PediatricsNagoya University Graduate School of MedicineNagoyaJapan

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