Endovascular Coil Migration to Duodenal Lumen After Gastroduodenal Artery Embolization in a 90-Year-Old-Woman, Complicating Upper-GI Bleed Management: A Case Report.

BACKGROUND Upper-gastrointestinal (GI) bleeds refractory to endoscopic hemostasis can be treated with endovascular coil embolization. Transcatheter arterial embolization with endovascular coils is an effective and minimally invasive option with high success rates, and coil migration is a rare complication. This report describes the case of a 90-year-old woman with an upper-GI bleed managed with emergency transcatheter arterial embolization, presenting with an endovascular coil migration. CASE REPORT A 90-year-old woman presented to the emergency department (ED) with abdominal pain, dizziness, and diarrhea (day 0). Imaging revealed a duodenal bulb ulcer with a contained perforation, for which she underwent endovascular coil embolization on day 2. Thirteen days later, during an outpatient esophagogastroduodenoscopy (EGD), the endovascular coil was identified at the junction of the duodenal bulb and second portion of the duodenum. The endovascular coil was not removed due to risk of bleeding. At 6 weeks, she re-presented with mild symptoms and was managed conservatively. At 4 months, she remained asymptomatic and the endovascular coil had not passed. At 21-month follow-up, the endovascular coil remained unpassed, with intermittent symptoms, a finding that highlights the long-term management and challenges of this complication. CONCLUSIONS Due to the rarity of endovascular coil migration, there is no standard method for managing this complication. It is important to assess each patient individually, manage patient symptoms, and consult with interventional radiology and surgery as needed. This case shows that reporting such cases is essential to expand the limited literature, inform best practices, and guide clinicians faced with this rare complication.