Nghe An General Friendship Hospital: Endovascular intervention saves patient in shock due to massive gastrointestinal bleeding

March 27,Nghe An General Friendship Hospitaladmitted patient LMT (born in 1973, in Quynh Thanh commune, Quynh Luu district). The patient was admitted with abdominal pain. Medical history 20 years ago, the patient had surgery for gallstones with cirrhosis.

During the monitoring and treatment process, on April 4, Patient LMT suddenly had increased abdominal pain, a gastric tube was inserted and there was a lot of fresh blood, rapid pulse, and low blood pressure. It was determined that hemorrhagic shock was suspected due to gastrointestinal bleeding.

Pseudoaneurysm of the right gastric artery causing blood leakage plus abnormal visceral artery anatomy. Photo: BVVHNDKNA

Through endoscopy, the doctors found a bleeding ulcer in the duodenum and tried to stop the bleeding but it was still bleeding so they ordered a further CT angiography of the visceral blood vessels. The results showed that the patient had a pseudoaneurysm of the right gastric artery causing blood leakage, plus an abnormal visceral artery anatomy (very rare, about 0.4 to 2%). The patient was quickly resuscitated, transfused with blood and fresh frozen plasma.

Interdisciplinary consultation with the hospital leadership determined that patient LMT was in hemorrhagic shock due to rupture of the right gastric artery aneurysm on the basis of anatomical abnormalities. This is an emergency condition, with a poor prognosis and immediate hemostasis is required otherwise the patient will be at risk of death due to hemorrhagic shock. The consultation panel decided to choose the method of imaging and endovascular intervention to occlude the ruptured pseudoaneurysm to stop the bleeding for the patient.

Immediately afterwards, Specialist 2 Doctor Nguyen Canh Cuong and the vascular intervention team of the X-Ray Department performed endovascular intervention to stop the patient's bleeding. After nearly 2 hours, the doctors successfully blocked the damaged artery, the patient stopped bleeding, ensuring the patient's life safety. After the intervention, patient LMT was taken back to the department for treatment and monitoring. Up to now, the blood test results have gradually returned to normal, the patient's health has stabilized and recovered well.

Damaged artery after treatment. Photo: BVHDKNA

According to Specialist Doctor 2 Nguyen Canh Cuong: This is a difficult intervention case when the patient has an abnormal visceral artery anatomy, leading to blood vessels becoming deformed and forming angles, making it difficult to insert devices to access the bleeding site. This requires the team to be highly focused during the technical implementation process.

It is known that endovascular intervention technique to treat organ bleeding is a technique that has long been performed only in large hospitals in Vietnam, where there are highly qualified human resources and modern equipment. This intervention technique helps patients with bleeding due to trauma such as: liver, spleen, kidney or pelvic injuries or cases of bleeding not due to trauma such as: ruptured tumors, gastrointestinal bleeding or vascular malformations... avoid surgery, as well as not having to remove damaged organs and maximally preserve damaged organs.

After the intervention, the patient's health gradually recovered well. Photo: Thanh Chung

In response to the treatment needs of people in the province and the region, Nghe An General Hospital has been performing endovascular intervention techniques since 2021 and has saved dozens of patients, as well as avoiding the need for major surgery and maximally preserving organs in the body thanks to this technique.

Associate Professor, Dr. Nguyen Van Huong - DirectorNghe An General Friendship Hospitalsaid: In 2023, the hospital has proposed a plan to develop new techniques, specialized techniques including 160 techniques, including 35 surgical techniques, nearly 70 emergency resuscitation and internal medicine techniques, more than 55 new techniques, advanced techniques of the paraclinical system.

In particular, the Hospital continues to develop advanced techniques in visceral vascular intervention, vascular malformations, visceral artery occlusion, superior gastro-mesenteric artery, general gastrointestinal vascular intervention, etc.

The staff of Nghe An General Friendship Hospital have been determined and trying to do well in developing specialized high technology to make an important contribution to the development of the unit worthy of being a special-class hospital in the North Central region; well meeting the treatment needs of the people of the province, the North Central region and Laos./.