Orgera Gianluigi, Ubaldi Nicolò, Rossi Tommaso, Rossi Michele, Krokidis Miltiadis
Department of Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy.
1st Department of Radiology, Areteion University Hospital, Medical School, National and Kapodistrian University of Athens, 76 Vas. Sophias Av, 11528, Athens, Greece.
Clin J Gastroenterol. 2024 Oct;17(5):834-838. doi: 10.1007/s12328-024-02018-6. Epub 2024 Jul 15.
Bariatric surgery may sometimes be challenging and may lead to severe complications. Surgical re-intervention in such cases is not the preferred option due to co-morbidities. When severe bleeding occurs, embolization of the lacerated vessels is the preferred minimal invasive management option and needs to be available if possible. We would like to report a case of young patient who underwent severe bleeding after migration of a gastric band. The patient was successfully embolized and the band was removed. However, on the second post-operative day, the patient complained again for acute abdominal pain and turned haemodynamically unstable. Fresh blood was aspirated from the surgical drain. A new emergency CT scan was performed and a new large pseudoaneurysm was revealed taking origin from the left gastric artery. The second bleeding occurred due to an anastomotic communication and was also successfully embolized. The main take home messages are that bariatric surgery may lead to several complications including bleeding, gastric band may cause vessel erosion but also offer a tamponade effect, endovascular embolization of the lacerated vessels is the preferred management and pseudoaneurysms arising in hepato-splenic or gastroduodenal arteries should be treated with the sandwich embolization technique.
减肥手术有时可能具有挑战性，并可能导致严重并发症。由于合并症，在这种情况下进行手术再次干预并非首选方案。当发生严重出血时，对撕裂血管进行栓塞是首选的微创治疗选择，如有可能应具备这种治疗手段。我们想报告一例年轻患者，其胃束带移位后发生严重出血。该患者成功接受了栓塞治疗并移除了束带。然而，术后第二天，患者再次抱怨急性腹痛，血流动力学变得不稳定。从手术引流管抽出了新鲜血液。进行了一次新的急诊CT扫描，发现一个新的大假性动脉瘤起源于胃左动脉。第二次出血是由于吻合口相通引起的，也成功进行了栓塞治疗。主要的经验教训是，减肥手术可能导致多种并发症，包括出血，胃束带可能导致血管侵蚀，但也具有压迫止血作用，对撕裂血管进行血管内栓塞是首选治疗方法，肝脾或胃十二指肠动脉出现的假性动脉瘤应采用三明治栓塞技术进行治疗。
