Gastric Necrosis: An Unexpected Complication of Transarterial Embolization in a Critically Ill Poly Trauma Patient

Abstract

Transarterial embolization (TAE) is an effective minimally invasive procedure used for the management of gastrointestinal bleeding in hemodynamically unstable patients. Although the procedure has a high technical success rate, ischemic complications such as gastric necrosis are extremely uncommon because of the rich vascular supply of the stomach. We report a rare case of gastric necrosis following TAE for a pseudoaneurysm of the right gastroepiploic artery in a 22-year-old polytrauma patient. The patient sustained multiple traumatic injuries following a fall from a train and subsequently developed hemorrhagic shock, disseminated intravascular coagulation (DIC), septic shock, and multiorgan dysfunction requiring extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Despite successful embolization with coils, the patient developed progressive gastric ischemia and necrosis requiring emergency total gastrectomy with Roux-en-Y esophagojejunostomy. The patient gradually recovered and was discharged on follow-up. This case highlights the importance of considering ischemic complications after TAE in critically ill trauma patients with severe coagulopathy, vasopressor dependence, and prolonged hypoperfusion. Early recognition and timely surgical intervention are essential for improving patient outcomes.