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A 44-year-old woman presented with hematemesis and melena. Laboratory evaluation showed a hemoglobin of 3.6 g/dL, down from 9.7 g/dL 1 month prior. An esophagogastroduodenoscopy revealed a large nonbleeding ulcer with a visible vessel in the duodenal bulb (Figure 1). Cauterization of the vessel was complicated by profuse bleeding and attempts to achieve hemostasis with epinephrine injection, electrocauterization, and clip placement failed. The patient subsequently underwent angiogram, which did not reveal any active extravasation. However, empiric coil embolization of gastroduodenal, inferior pancreaticoduodenal, and right gastroepiploic arteries was performed successfully (Figure 2). Repeat esophagogastroduodenoscopy 3 days later for continued melena showed the large duodenal ulcer with the embolization coils eroding through the ulcer bed into the duodenal lumen (Figure 3).

Coil Erosion Into the Duodenum Following Arterial Embolization