Intra-abdominal hemorrhage caused by omental artery rupture is a rare condition. There are few reports on the treatment of omental artery rupture with only transcatheter arterial embolization (TAE). A 27-year-old man presented to our emergency room with upper abdominal pain that suddenly occurred during sleep. Abdominal computed tomography (CT) revealed fluid collection in the peritoneal cavity and a left subphrenic hematoma with extravasation. Celiac angiography revealed extravasation from the omental artery, which arose from the proximal left gastroepiploic artery. A microcatheter was advanced into the left gastroepiploic artery and around the culprit artery bifurcation, which was embolized by inserting coils. The postoperative course was uneventful without worsening of anemia or abdominal symptoms. The patient was discharged after the absence of extravasation was confirmed by contrast-enhanced CT. Although surgical therapy has often been performed for omental bleeding, TAE, which is less invasive and has the advantage of simultaneous diagnosis and treatment, should be attempted as the first-choice therapy.
Rupture of the omental artery is a relatively rare condition that can lead to life-threatening intra-abdominal hemorrhage [
A 27-year-old man presented to our emergency unit after having been woken from sleep at midnight because of severe abdominal pain. His medical and familial histories were unremarkable. His vital signs and laboratory evaluation results, including the hemoglobin level (15.2 g/dL), showed no abnormalities. He was suspected to have gastritis and was discharged with an H2-blocker. However, the abdominal pain did not improve. It worsened when stretching his back and breathing. He returned to our hospital because of temporary loss of consciousness when rising from his bed the next morning.
Contrast-enhanced CT revealed high-density ascites retention that was thought to contain blood. There was a left subphrenic hematoma compressing the stomach and spleen with extravasation (Figure
Abdominal enhanced CT revealed a hematoma (arrows) with extravasation (arrowheads) located in the left part of the omentum and relatively high-attenuation fluid in the abdominal cavity.
After the insertion of a 5-F sheath introducer from the right femoral artery under local anesthesia, a 5-F shepherd hook catheter (Terumo Clinical Supply, Tokyo, Japan) was advanced through the sheath introducer with its tip positioned in the celiac artery. Celiac arteriography revealed bleeding from the omental artery, which arose from the left gastroepiploic artery (Figure
Celiac and left gastroepiploic arteriography revealed active extravasation (arrow) of the omental artery arising from the left gastroepiploic artery (a, b, c).
Celiac arteriography after embolization revealed arrested bleeding from the omental artery. Microlocoils are placed in a left gastroepiploic artery (arrow).
The patient’s abdominal pain was relieved, and progression of anemia was not observed after the procedure. Two days after the procedure, contrast-enhanced CT revealed no extravasation. No complications or rebleeding occurred, and he was discharged on the 10th hospital day.
Rupture of the omental artery is a rare condition that can cause intra-abdominal hemorrhage [
The age of onset of spontaneous rupture of the omental artery ranges widely from the 20 s to 80 s [
Matsuda reviewed 37 cases of spontaneous rupture of the omental artery reported from 1986 to 2010 in Japan [
However, there have been few reports on TAE for spontaneous rupture of the omental artery, including only one case reported in English and three cases in Japanese [
One of the reasons that surgical treatment has been frequently performed for omental bleeding is that very few cases have been correctly diagnosed before treatment. According to the report by Matsuda [
TEA is less invasive than surgical treatment and has the advantage of simultaneous diagnosis and treatment. The omental arteries arising from the left and right gastroepiploic arteries are anastomosed to each other in the periphery. The omental artery does not provide the main blood supply to organs other than the omentum. Therefore, TAE for the omental artery is considered to be a procedure with a low risk of major emboli in other organs. Serious complications were not observed in the four cases treated with TAE.
However, TAE should be carefully performed in the case of proximal embolization because of the possibility of rebleeding through the collateral circulation [
Absence of bleeding from a collateral route should be confirmed by angiography not only from one side of the gastroepiploic artery, but also from the root of the celiac artery. If TAE does not result in complete embolization, placing a microcoil in the artery adjacent to a bleeding site may provide an indication of the bleeding site when surgical treatment is subsequently performed.
TAE successfully stopped the bleeding of the omental artery that developed in a young patient with no specific trigger. Because TAE for the omental artery is an easy technique with a low risk of complications, it should be attempted as the first-choice therapy.