Massive bleeding after EUS-guided walled-off necrosis drainage

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Presentation transcript:

Massive bleeding after EUS-guided walled-off necrosis drainage Lady Katherine Mejía Pérez, MD, Bhaumik Brahmbhatt, MBBS, Victoria Gómez, MD VideoGIE Volume 3, Issue 1, Pages 13-14 (January 2018) DOI: 10.1016/j.vgie.2017.09.014 Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 A, Preprocedural abdominal MRI demonstrating a large (12.3 × 7.4 × 6.4 cm) complex fluid collection with a thick outer wall surrounding the pancreatic body (arrow) and suspected disruption of the pancreatic duct (arrowheads). B, EUS view demonstrating the LAMS catheter (arrowhead) inside the collection, and the distal end of the deployed stent (arrow). C, Upper endoscopic view showing dilation of the cystgastrostomy by use of a wire-guided dilating balloon. D, Upper endoscopic view showing bleeding at the proximal end of the LAMS (gastric side). E, Arteriographic view showing the deployed LAMS (arrow) and no evidence of extravasation of contrast material. F, Duodenoscopic view revealing the previously placed cystgastrostomy stent on the gastric body. A hemostatic clip is seen at the site of active bleeding underneath the stent. G, EGD view demonstrating the gastric side of the cystgastrostomy without bleeding. H, MRI revealing nearly resolved walled-off necrosis (arrow). I, EGD views before (left) and after (right) LAMS removal. MRI, magnetic resonance imaging; LAMS, lumen-apposing metal stent. The arrow represents the place where the stent was. VideoGIE 2018 3, 13-14DOI: (10.1016/j.vgie.2017.09.014) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 A, Preprocedural abdominal MRI demonstrating a large (12.3 × 7.4 × 6.4 cm) complex fluid collection with a thick outer wall surrounding the pancreatic body (arrow) and suspected disruption of the pancreatic duct (arrowheads). B, EUS view demonstrating the LAMS catheter (arrowhead) inside the collection, and the distal end of the deployed stent (arrow). C, Upper endoscopic view showing dilation of the cystgastrostomy by use of a wire-guided dilating balloon. D, Upper endoscopic view showing bleeding at the proximal end of the LAMS (gastric side). E, Arteriographic view showing the deployed LAMS (arrow) and no evidence of extravasation of contrast material. F, Duodenoscopic view revealing the previously placed cystgastrostomy stent on the gastric body. A hemostatic clip is seen at the site of active bleeding underneath the stent. G, EGD view demonstrating the gastric side of the cystgastrostomy without bleeding. H, MRI revealing nearly resolved walled-off necrosis (arrow). I, EGD views before (left) and after (right) LAMS removal. MRI, magnetic resonance imaging; LAMS, lumen-apposing metal stent. The arrow represents the place where the stent was. VideoGIE 2018 3, 13-14DOI: (10.1016/j.vgie.2017.09.014) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions