Wang Han, Tan Yi-Qing, Han Ping, Xu An-Hui, Mu Han-Lin, Zhu Zhe, Ma Li, Liu Mei, Xie Hua-Ping
Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.
Department of Radiology, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan University, Wuhan 430063, Hubei Province, China.
World J Gastrointest Surg. 2024 Sep 27;16(9):3057-3064. doi: 10.4240/wjgs.v16.i9.3057.
Gastric submucosal arterial dilation resulting from splenic artery occlusion represents an exceedingly rare etiology of acute upper gastrointestinal bleeding (UGIB). Although endoscopy is a widely utilized diagnostic and therapeutic modality for gastrointestinal bleeding, it has limitations in detecting arterial abnormalities.
This report presents a rare case of massive UGIB in a 57-year-old male with a tortuous left inferior phrenic artery accompanied by splenic artery occlusion. "Gastric varices" was identified during the patient's endoscopy one year before hemorrhage. Despite initial hemostasis by endoscopic clipping, the patient experienced massive rebleeding after one month, requiring intervention with transcatheter arterial embolization (TAE) to achieve hemostasis.
This is the first case to report UGIB due to a tortuous left inferior phrenic artery. This case highlights the limitations of endoscopy in identifying arterial abnormalities and emphasizes the potential of TAE as a viable alternative for the management of arterial bleeding in the gastrointestinal tract.
脾动脉闭塞导致胃黏膜下动脉扩张是急性上消化道出血（UGIB）极为罕见的病因。尽管内镜检查是广泛用于胃肠道出血的诊断和治疗方式，但在检测动脉异常方面存在局限性。
本报告介绍了一例罕见的大量UGIB病例，患者为一名57岁男性，左膈下动脉迂曲并伴有脾动脉闭塞。在出血前一年的内镜检查中发现了“胃静脉曲张”。尽管通过内镜夹闭实现了初步止血，但患者在一个月后出现大量再出血，需要行经导管动脉栓塞术（TAE）进行干预以实现止血。
这是首例报告因左膈下动脉迂曲导致UGIB的病例。该病例突出了内镜检查在识别动脉异常方面的局限性，并强调了TAE作为胃肠道动脉出血管理的可行替代方法的潜力。
