Endovascular management of delayed upper gastrointestinal bleeding after open esophagectomy for a benign oesophageal stricture

Abstract

Introduction: Delayed upper gastrointestinal (GI) bleeding is a rare complication of esophagectomy and can be difficult to manage. Presentation: A 76-year-old female represented 17 days post open esophagectomy with an unstable upper GI bleed. When control could not be achieved endoscopically, she was transferred to the Radiology Department where a triphasic CT angiogram confirmed active contrast extravasation into the gastric tube. She proceeded to the Interventional Radiology suite where a thoracic angiogram revealed an active arterial bleed from a branch of the thyrocervical trunk. The bleeding vessel was successfully embolised with coils and haemostasis was achieved. Discussion: Management options for upper GI bleeding post esophagectomy include medical, endoscopic and endovascular approaches. Conclusion: Our case represents a rare example of delayed bleeding into a gastric conduit post open esoph-agectomy for a benign stricture. The case reinforces: a) The management options available for controlling an acute upper GI bleed. b) The value of a CT angiogram in identifying the site of bleeding and mapping the relevant vascular anatomy prior to embolization. c) How endovascular embolization is a minimally invasive and potentially life-saving intervention for bleeds that cannot be controlled endoscopically.