動脈塞栓術にて止血しえた十二指腸傍乳頭憩室出血の１例

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A man in the 7th decade complaining of melena was admitted to our hospital. Emergency gastroduodenoscopy demonstrated massive hemorrhage from a parapapillary diverticulum. Endoscopic treatment failed to achieve hemostasis, and the patient received emergency angiography. CT arteriography via the right branch of the posterior superior pancreaticoduodenal artery (PSPDA) revealed contrast medium leakage in the parapapillary diverticulum, which could not be detected by digital subtraction angiography (DSA). Superselective transcatheter arterial embolization (TAE) of the branch using N-butyl cyanoacrylate achieved hemostasis. However, hemorrhage recurred on the next day. DSA showed an extravasation from the left branch of the PSPDA, which was embolized with microcoils continuously. The patient was discharged 13 days after the 2nd TAE procedure without recurrent hemorrhage. In conclusion, TAE is a valuable treatment for acute massive hemorrhage from parapapillary diverticulum when endoscopic treatment is difficult.
一般社団法人日本インターベンショナルラジオロジー学会の論文