Surgical Removal of Migrated Coil after Embolization of Jejunal Variceal Bleeding: A Case Report

Junhwan Kim; Danbi Lee; Kyunghwan Oh; Mingee Lee; Seol So; Dong-Hoon Yang; Chan-Wook Kim; Dong Il Gwon; Young-Hwa Chung

doi:10.4166/kjg.2017.69.1.74

Journal List > Korean J Gastroenterol > v.69(1) > 1007670

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Kim, Lee, Oh, Lee, So, Yang, Kim, Gwon, and Chung: Surgical Removal of Migrated Coil after Embolization of Jejunal Variceal Bleeding: A Case Report

Case Report

Korean J Gastroenterol 2017;69(1):74-78.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.69.1.74

Surgical Removal of Migrated Coil after Embolization of Jejunal Variceal Bleeding: A Case Report

Junhwan Kim, Danbi Lee, Kyunghwan Oh, Mingee Lee, Seol So, Dong-Hoon Yang, Chan-Wook Kim¹, Dong Il Gwon², Young-Hwa Chung

Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea

¹Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea

²Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to: Danbi Lee, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3907, Fax: +82-2-476-0824, E-mail: leighdb@hanmail.net

Received 11 October 2016 Revised 23 November 2016 Accepted 1 December 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Jejunal variceal bleeding is less common compared with esophagogastric varices in patients with portal hypertension. However, jejunal variceal bleeding can be fatal without treatment. Treatments include surgery, transjugular intrahepatic portosystemic shunt (TIPS), endoscopic sclerotherapy, percutaneous coil embolization, and balloon-occluded retrograde transvenous obliteration (BRTO). Percutaneous coil embolization can be considered as an alternative treatment option for those where endoscopic sclerotherapy, surgery, TIPS or BRTO are not possible. Complications of percutaneous coil embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after percutaneous coil embolization for jejunal variceal bleeding. The migrated coil was successfully removed using surgery.

Keywords: Migrated coil, Coil migration, Small bowel varix, Jejunal varix, Embolization

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Fig. 1.

(A) Jejunal varices (arrows) were observed on the portal phase of CT scan. (B) Small bowel video capsule endoscopy revealed a dumbbell-shaped varix (arrows). A dimple on the surface (arrowhead) is suggestive of a recent bleeding stigma.

Fig. 2.

(A). Angiography showing tortuous jejunal varices. Embolization was performed using coil and N-butyl-2-cyanoacrylate (Histoacryl). (B, C) CT scan after embolization showing coil and Histoacryl, and varices were invisible (white arrows).

Fig. 3.

CT showing a linear high density material from the small bowel (A) to the mid to distal transverse colon (B). (C) Abdominal x-ray showing a linear material (white arrows).

Fig. 4.

Colonoscopy showing a migrated coil.

Fig. 5.

Migrated coil (white arrow).

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