# Transcatheter embolization for duodenal ulcer bleeding originating from cystic artery erosion

## TL;DR

This paper reports three cases where bleeding from a rare type of duodenal ulcer was successfully treated with a minimally invasive artery embolization technique instead of surgery.

## Contribution

The study demonstrates the effectiveness of transcatheter embolization of the cystic artery for treating rare duodenal ulcer bleeding.

## Key findings

- Three elderly patients with duodenal ulcer bleeding were successfully treated with cystic artery embolization.
- Transcatheter embolization proved to be a safe and effective alternative to surgery for this rare condition.
- Empirical embolization of the gastroduodenal artery failed, but super-selective cystic artery embolization succeeded in achieving hemostasis.

## Abstract

Ulcer erosion into the cystic artery is a rare cause of bleeding in duodenal ulcers, with only a limited number of cases described in the literature. Historically, treatment has predominantly involved surgical intervention. We present three cases of duodenal ulcer bleeding due to cystic artery erosion, which were successfully managed with cystic artery embolization.

This case series includes three male patients with duodenal ulcer bleeding, aged 90, 81, and 82 years, respectively, and no prior history of biliary system disorders. The ulcer locations were identified as two in the post-bulbar region and one in the anterior bulb. After the failure of medical and endoscopic treatment, transcatheter arterial embolization was adopted. Initial angiography did not reveal any contrast medium extravasation. Empirical embolization of the gastroduodenal artery using gelatin sponge particles and coils failed to achieve hemostasis. Super-selective cystic artery angiography confirmed the source of bleeding as the cystic artery. One patient was embolized with gelatin sponge particles and coils, while the other two patients were embolized with N-butyl-cyanoacrylate. All patients achieved successful hemostasis without gallbladder infraction.

Cystic artery embolization proved to be a minimally invasive technique for achieving hemostasis in these cases, indicating that it may be a safe and effective alternative to surgery for this uncommon cause of upper gastrointestinal bleeding. Validation through further studies is warranted.