The nonoperative treatment of massive pyloroduodenal hemorrhage by retracted autologous clot embolization.

Six patients with massive pyloroduodenal hemorrhage were treated by selective embolization of retracted autologous clot to occlude the bleeding vessels. All patients had severe associated illnesses and were very poor candidates for operative treatment. The actively bleeding vessel was occluded successfully and hemorrhage was controlled with autologous clot alone in five of these patients, although two patients later bled from other sites. Although three patients died, none died as a direct result of bleeding. The only complication encountered, multiple small hepatic infarct, occurred when the embolized clot migrated from the gastroduodenal artery to the hepatic artery. A method of avoiding this complication is presented. Selective emolization of retracted autologous clot represents a useful alternative to the operative management of massive pyloroduodenal hemorrhage and should be considered for the treatment of patients whose associated diseases make them poor candidates for operative treatment.