Successful bronchial artery embolization for refractory esophageal bleeding after failed endoscopic therapy

Abstract

A 51-year-old man with chronic alcoholism was admitted to the emergency unit with hematemesis (750 mL). Emergency endoscopy revealed active bleeding from a longitudinal laceration in the lower esophageal wall. The laceration was approximately 3.5 cm long and located 35 cm from the incisor teeth ([Fig. 1]). Despite the application of more than 30 hemoclips and several rubber bands, bleeding was not controlled. As he was hemodynamically unstable, a transfemoral angiogram was performed to find the bleeding artery. The celiac angiogram showed that the left gastric or other arteries did not supply the area being clipped. We found dye leakage from a small branch of the right bronchial artery ([Fig. 2 a]). We embolized the bronchial artery with two 2-cm-long helical coils (Hilal Embolization Microcoil™, Cook, Bloomington, Indiana, USA). A follow-up angiogram revealed an occluded bronchial artery with no leakage ([Fig. 2 b]). Follow-up endoscopy 3 days later showed a healed ulcer at the laceration site ([Fig. 3]). The patient was discharged without further complications.