Delayed superior epigastric artery pseudoaneurysm following percutaneous radiologic gastrostomy: Treatment by percutaneous embolization with N-butyl cyanoacrylate

Percutaneous radiologic gastrostomy (PRG) is a widely used procedure with a low rate of serious complications and with comparable short-term outcomes with percutaneous endoscopy. Hemorrhagic complications are rare (1.4%), and occur usually immediately after the procedure due to direct arterial punctures. We report on the case of a 62-year-old male patient with a diagnosis of multi-systemic atrophy disease that was referred to our tertiary center for PRG. The procedure was performed without early complications. He presented a slight bleeding 3 weeks of the procedure. A CT angiogram revealed a pseudoaneurysm of the left superior epigastric artery, in contact with the gastrostomy tube. After a failed surgical treatment, the patient was successfully treated by percutaneous embolization using a mixture of Glubran 2 and Lipiodol, under ultrasound and fluoroscopic control. This case study suggested that a slight hemorrhage following PRG may suggest a pseudoaneurysm and a CT angiogram should be performed.