case_images: PMC10923589_01
case_images: a Biliopancreatic diversion with duodenal switch (BPD-DS). b Previous sleeve gastrectomy consistent with history of duodenal switch.
case_images: crg-2024-0018-0001-536095_F01.jpg
case_images: PMC10923589_01_crg-2024-0018-0001-536095_F01.jpg
case_images: F1
case_images: She was transferred to a tertiary care center where an upper endoscopy and small bowel video capsule endoscopy identified no source for bleeding (shown in Fig. 1b).
case_images: a CT enterography with specialized small bowel GI bleed protocol designed by TJUH. b, c GI bleed in the duodenum visualized as a blush in the duodenal lumen on both the arterial and delay phase of CT enterography with small bowel GI bleed protocol. CT, computerized tomography; TJUH, Thomas Jefferson University Hospital.
case_images: crg-2024-0018-0001-536095_F02.jpg
case_images: PMC10923589_01_crg-2024-0018-0001-536095_F02.jpg
case_images: F2
case_images: CT enterography (institutional small bowel GIB protocol) 3 days later showed GIB in the duodenum (shown in Fig. 2).
case_images: a Pre-embolization selective arteriography with microcatheter in gastroduodenal artery (*) (GDA) showing no active bleeding. b Active contrast extravasation (arrow) from superior pancreaticoduodenal artery branch at site of bleeding. c Post-microcoil embolization of the superior pancreaticoduodenal artery, selective GDA arteriogram demonstrates no further bleeding.
case_images: crg-2024-0018-0001-536095_F03.jpg
case_images: PMC10923589_01_crg-2024-0018-0001-536095_F03.jpg
case_images: F3
case_images: Following coil embolization of the proximal right gastroepiploic artery, the gastroduodenal artery was embolized with Gelfoam slurry in order to limit collateral flow to the area of bleeding (shown in Fig. 3).