A Rare Cause of Upper Gastrointestinal Bleeding

Excerpt

A 60-year-old male patient with peripheral artery occlusive disease underwent esophagogastroduodenoscopy for hematemesis. Esophagogastroduodenoscopy revealed nonpulsatile submucosal vascular structures in the gastric fundus. A 0.3 cm ulcer was found on one of the lesions. (Figure A). Computed tomography angiography (CTA) revealed splenic artery thrombosis and collateral arteries from the splenic artery and left gastric artery to the gastric wall (Figure B). Therefore, gastric submucosal arterial collaterals (GSAC) with bleeding were diagnosed. Esophagogastroduodenoscopy two days after CTA revealed active bleeding from the ulcer, and hemostasis was achieved by endoscopic clipping. Angiography demonstrated thrombosis of the distal splenic artery with collateral arteries arising from the left gastric artery (Figure C, black arrow) and spleen artery (Figure C, white arrow). Transcatheter arterial embolization (TAE) to left gastric arteries was performed. Follow-up esophagogastroduodenoscopy four months later revealed shrinkage of the vessels. (Figure D).

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