Local recurrence of renal cell carcinoma presented with massive gastrointestinal bleeding: management with renal artery embolization

Donya Farrokh,Reza Akhavan,Reihaneh Mortazavi,Bita Abbasi,Masoud Pezeshki Rad

doi:10.1186/s42155-019-0054-4

Donya Farrokh, Reza Akhavan + Show 3 more

Open Access

https://doi.org/10.1186/s42155-019-0054-4

Copy DOI

Journal: CVIR endovascular	Publication Date: Mar 15, 2019
Citations: 1	License type: open-access

Affiliation: Mashhad University of Medical Sciences

Abstract

BackgroundGastrointestinal bleeding from renal cell carcinoma metastasis is an uncommon manifestation of tumor recurrence and is usually difficult to control. Palliative trans-catheter embolization to control the bleeding has been used and described in the literature.Case presentationThe present report describes a 62- years-old male with local recurrence of RCC who presented with upper GI bleeding as the primary manifestation 10 years after right-sided partial nephrectomy. A pseudoaneurysm of renal artery with erosion into the duodenal lumen was responsible for the massive bleeding and was controlled with coil embolization.ConclusionThis case report highlights the importance of high index suspicion in post-nephrectomy patients for RCC, presenting with new symptoms. Aggressive gastrointestinal workup and adequate awareness of available minimally-invasive endovascular options for controlling GIB in these patients, are of paramount importance.

Highlights

ConclusionThis case report highlights the importance of high index suspicion in post-nephrectomy patients for Renal cell carcinoma (RCC), presenting with new symptoms
Gastrointestinal bleeding from renal cell carcinoma metastasis is an uncommon manifestation of tumor recurrence and is usually difficult to control
This case report highlights the importance of high index suspicion in post-nephrectomy patients for Renal cell carcinoma (RCC), presenting with new symptoms

Summary

Conclusion

Gastrointestinal metastases are rare causes of GIB (Bhatia et al, 2006). GI involvement can be due to direct extension of primary or recurrent tumor in the renal bed or from hematogenous metastasis (Fidelman et al, 2010). Endoscopic hemostatic control of GIB is usually difficult and in selected cases, intractable GI bleeding can be controlled by endovascular embolization of the tumor-supplying artery (Barth, 1991). This is only a palliative treatment and collateral vessels which have potential for re-bleeding may eventually develop at the site of metastatic lesion. To the best of our knowledge, in all reported cases of GIB secondary to RCC metastasis treated with endovascular approach, a tumor-supplying artery (including mesenteric, celiac, lumbar or intercostal branches) was embolized for hemostatic control. Endovascular embolization and coiling of the pseudoaneurysm was performed as an emergent life-saving procedure This case report highlights the importance of high index suspicion in post-nephrectomy patients for RCC, presenting with new symptoms.

Background