Fig. 9
Acute intraluminal bleeding in the duodenum manifesting with acute abdominal pain and impending haemodynamic shock, hours after an unsuccessful endoscopic attempt to relieve the intrahepatic biliary obstruction in 77-year-old female with recently diagnosed infiltrating gallbladder carcinoma. Operative ERCP was interrupted after sphincterotomy because of duodenal haemorrhage, which was treated with epinephrine injection and endoluminal clipping. Comparison of unenhanced (a) and arterial-phase (b, c) CT images detected active contrast extravasation in the duodenal lumen (arrowheads) abutting the metallic clips (thin arrows), consistent with persistently ongoing arterial haemorrhage. Endovascular therapeutic embolisation of the gastroduodenal artery was necessary to control bleeding