Transcatheter Intra-arterial Vasopressin for Infusion Gastric Pouch Bleeding after Roux-en-Y Gastric Bypass: Report of a Case

Abstract

Roux-en-Y gastric bypass has been accepted as one of standard treatment procedures for morbidly obese patients. During the early postoperative stage, gastrointestinal hemorrhage is a complicated condition to manage. Management involves different strategies according to the patient's condition. Observation, blood transfusion, endoscopic hemostasis, or re-operation is the most frequently adopted method. Here, we report on a 51-year-old morbidly obese patient who developed early postoperative hemorrhage from the gastric pouch. Neither medical treatment nor endoscopy succeeded in stopping the bleeding. In order to obviate the possibility of embolization of the only arterial supply to the gastric pouch from the left gastric artery (LGA), we infused transcatheter intra-arterial vasopressin and successfully achieved hemostasis. We believe, this is the first case using this type of intervention to manage gastric pouch hemorrhage after laparoscopic Roux-en-Y gastric bypass (LRYGB). We advocate that this method be accepted as one of the treatment modalities before considering re-operation.