Cornish Nathan,  Cornish Anna,  Shah Jay,  Sarkar Debkumar,  Honig Shaun,  Sobolevsky Sergei

Final Pr. ID: Poster #: EDU-114

The role of transarterial embolization has been well studied in adults but data is lacking in the pediatric population. As a newly designated level 1 trauma center we present our institutional experience of the efficacy and safety of transarterial embolization for pediatric abdominal and pelvic trauma as well as a review of the current literature. We discuss the multidisciplinary approach to management and the role of the interventionalist as a clinician. Read More

Authors:  Cornish Nathan , Cornish Anna , Shah Jay , Sarkar Debkumar , Honig Shaun , Sobolevsky Sergei

Keywords:  Arterial Embolization, Trauma, Splenic Artery Embolization

Dennison Jennifer,  Nassar Arianna,  Carter Scott,  Kouri Brian

Final Pr. ID: Poster #: CR-032

Endoscopy-guided and image-guided gastrostomy tube placements have similar complication rates and range from 0.4-22.5% and 13-43% respectively. Of these, vascular injury occurs in approximately 1.4-2.5%. Understanding the imaging features, clinical presentations, and management of rare, severe, gastrostomy-related complications is crucial for early, accurate diagnosis and favorable outcomes. We present a rare case of exclusively intragastric hemorrhage from iatrogenic injury of an inferior epigastric artery following percutaneous gastrostomy tube placement. Case Report: A 4-year-old male patient with chronic constipation, failure to thrive, and developmental delay was admitted for abdominal distention and dysuria. A barium enema and biopsy confirmed short-segment Hirschsprung’s disease. He subsequently underwent diverting descending colostomy/mucous fistula creation, and laparoscopic gastrostomy tube placement. The following day he had a large-volume hematemesis. Hemoglobin was found to be 6.7 g/dL down from 12.4 g/dL preoperatively. Dark bloody output was noted in the gastrostomy tube trap. Emergent endoscopy demonstrated a massive amount of clot in the gastric lumen, and an obvious active bleed at the gastrostomy site with blood tracking along the gastrostomy tube stem. There was no evidence of hematoma or hemorrhage outside of the stomach by physical exam or endoscopy. A single bleeding vessel or pinpoint site amenable to endoscopic intervention was not identified. The patient proceeded to interventional radiology where initial angiography failed to identify an arterial source of bleeding involving the area suspected by endoscopy. The decision was made to empirically embolize the right gastroepiploic artery with gelfoam pledgets and slurry, as it was a low-risk intervention and the most likely source of arterial perfusion to the gastrostomy site. Further interrogation ultimately led, however, to identification of an active intragastric hemorrhage arising from a branch of the left inferior epigastric artery which was coil embolized. The patient recovered without incident and was discharged home 11 days later. Read More

Authors:  Dennison Jennifer , Nassar Arianna , Carter Scott , Kouri Brian

Keywords:  Arterial Embolization, Gastrostomy, Interventional Procedure