Figure 7.

Digestive hemorrhage after endoscopic papillotomy. The patient was treated by embolization of the gastroduodenal artery with coils placed distally and proximally to the source of bleeding. A week later she had a new episode of hemorrhage. (A) Arteriography from the proper hepatic artery shows good occlusion of the gastroduodenal artery. (B) Catheterization of the posteroinferior pancreatoduodenal branch. Return of the bleeding. (C) Arteriography taken during the embolization of both arteries, persistent hemorrhage. (D) Arteriography taken after the embolization of the pancreatoduodenal arch. Persistent hemorrhage. Coil in superior mesenteric artery, which was extracted with a gooseneck. (E) Selective catheterization of an accessory pancreatoduodenal branch, which comes from the origin of the aberrant right hepatic artery. (F) Arteriography taken after the embolization, with segments of gelfoam, of the aberrant artery. The bleeding has stopped. The patient has had no further episodes of hemorrhage.