A 67-year-old man with a history of alcoholism and nonsteroidal anti-inflammatory drug (NSAID) use was hospitalized 1 year ago with melena. Upper endoscopy demonstrated active bleeding from a 3-cm distal duodenal bulb ulcer. Given inability to control bleeding endoscopically, he underwent successful placement of two endovascular coils embolizing his gastroduodenal artery. He subsequently presented to our facility with 1 month of post-prandial nausea and epigastric pain. He stopped taking NSAIDs but continued to drink four standard drinks daily. Computed tomography of the abdomen demonstrated partial migration of an embolization coil into the duodenal lumen (Figure 1A). Esophagogastroduodenoscopy demonstrated mild antral gastropathy, a duodenal deformity, and partial migration of the embolization coil into the bulb (Figure 1B,C) with a 3-mm area of superficial ulceration where the coil protruded into the lumen. Gastric biopsies were negative for Helicobacter pylori. Given the absence of luminal obstruction, minimal ulceration, and lack of compliance to acid suppressive therapy, a decision was made to manage the patient conservatively with proton-pump inhibitor therapy. Coil removal was felt to pose significant risks of hemorrhage and was considered if conservative measures fail. Two weeks from discharge, the patient reported improvement in his nausea, mild persistent dyspepsia, and had no recurrent bleeding.
Figure 1.
Coil migration into the duodenum. (A) Computed tomography demonstrating intra-luminal coil migration (red circle); (B,C) White light examination of the duodenum.
Funding
None declared.
Author Contributions
All of the authors have contributed equally to the manuscript drafting and preparation. Z.I. and K.R. have taken care of the patient during his hospitalization.
Conflict of Interest
The authors report no conflicts of interest.
Contributor Information
Mahmoud Isseh, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Leen Z Hasan, Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA.
Zaid Imam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, Michigan, USA.
Justin Armstrong, Department of Internal medicine, William Beaumont Hospital-Royal Oak, Royal Oak, Michigan, USA.
Ketan Rana, Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, Michigan, USA.