International Journal of Surgery Case Reports | 2021
A case report of endovascular management of delayed upper gastrointestinal bleeding after open esophagectomy for a benign esophageal stricture
Abstract
Introduction Delayed upper gastrointestinal (GI) bleeding is a rare complication of esophagectomy and can be difficult to manage. Presentation A 76-year-old female represented 17 days post open esophagectomy with an unstable upper GI bleed. When control could not be achieved endoscopically, she was transferred to the Radiology Department where a triphasic CT angiogram confirmed active contrast extravasation into the gastric tube. She proceeded to the Interventional Radiology suite where a thoracic angiogram revealed an active arterial bleed from a branch of the thyrocervical trunk. The bleeding vessel was successfully embolised with coils and haemostasis was achieved. Discussion Management options for upper GI bleeding post esophagectomy include medical, endoscopic and endovascular approaches. Conclusion Our case represents a rare example of delayed bleeding into a gastric conduit post open esophagectomy for a benign stricture. The case reinforces:a) The management options available for controlling an acute upper GI bleed.b) The value of a CT angiogram in identifying the site of bleeding and mapping the relevant vascular anatomy prior to embolization.c) How endovascular embolization is a minimally invasive and potentially life-saving intervention for bleeds that cannot be controlled endoscopically.