Successful percutaneous treatment for massive hemorrhage due to infectious pseudoaneurysm in the abdominal wall after percutaneous endoscopic gastrostomy: a case report

• Published in: BMC Research Notes Vol. 7; no. 1; p. 354
• Main Authors: Fujita, Takeshi, Tanabe, Masahiro, Iida, Etsushi, Matsunaga, Naofumi, Ito, Katsuyoshi
• Format: Journal Article
• Language: English
• Published: London Springer Science and Business Media LLC 10.06.2014; BioMed Central; BioMed Central Ltd
• Subjects: Abdominal Wall; Abdominal Wall - pathology; Aged; Aneurysm, False; Aneurysm, False - complications; Biochemistry, Genetics and Molecular Biology(all); Biomedical and Life Sciences; Biomedicine; Care and treatment; Case Report; Complications and side effects; Endoscopy; Endoscopy - adverse effects; Endoscopy - methods; Gastrostomy; Gastrostomy - adverse effects; Gastrostomy - methods; Health aspects; Humans; Infectious pseudoaneurysm; Life Sciences; Male; Medicine(all); Medicine/Public Health; n-butyl-cyanoacrylate-lipiodol; Patient outcomes; Percutaneous endoscopic gastrostomy; Shock; Shock, Hemorrhagic; Shock, Hemorrhagic - diagnostic imaging; Shock, Hemorrhagic - etiology; Shock, Hemorrhagic - therapy; Skin; Tomography, X-Ray Computed; Weight loss; Abdominal wall; n-butyl-cyanoacrylate-lipiodol; Infectious pseudoaneurysm; Percutaneous endoscopic gastrostomy
• ISSN: 1756-0500; 1756-0500
• DOI: 10.1186/1756-0500-7-354

Background Percutaneous endoscopic gastrostomy (PEG) is often performed for alimentation and to prevent weight loss in patients with feeding problems due to central neurologic diseases such as cerebral infarction or intracranial hemorrhage. Although infection at the skin site after PEG placement is a typical late complication of PEG, a ruptured infectious pseudoaneurysm caused massive bleeding adjacent to the tract is rare. Prompt treatment is required to avoid the hemorrhage shock, however surgical ligation is difficult to obtain the arrest of bleeding in damaged skin due to the infection. Case presentation A 70-year-old male was bedridden due a cerebral infarction suffered 1 year previously. APEG was placed because of feeding problems, and a push-type, 20-Fr gastrostomy tube was inserted through the anterior abdominal wall. On day 16 after PEG placement, the patient had massive bleeding from the PEG site due to the rupture of infectious pseudoaneurysm and developed a decreased level of consciousness and hypotension. Treatment by percutaneous direct injection of a mixture of n-butyl-cyanoacrylate (NBCA)-lipiodol was performed and achieved good hemostasis is obtained. Conclusions A rare case of an infectious pseudoaneurysm that developed in the abdominal wall and caused massive bleeding at a PEG placement site was described. Percutaneous injection of a mixture of n-butyl-cyanoacrylate (NBCA)-lipiodol under ultrasound guidance is an effective treatment in this case.