A case of endoscopic hemostasis with intra-aortic balloon occlusion for severe bleeding from duodenal invasion from a pancreatic carcinoma

A 71-year old man was admitted to our hospital in an unconscious state with hematemesis. Upper gastrointestinal endoscopy showed an ulcer in the duodenal bulb with an exposed vessel. On treatment with endoscopic clipping for hemostasis, the vessel strated to spurt large quantities of blood, and eventually we lost sight of it. The patient was in a state of life-threatening hemorrhagic shock. Therefore, we decided to insert an intra-aortic balloon occlusion (IABO) catheter to counteract the bleeding and treat the shock. The IABO helped to maintain the blood pressure in the upper half of the patient's body, and reduced the ulcer bleeding. It also enabled us to relocate the vessels and complete endoscopic hemostasis with clipping. A few days later, the ulcer was diagnosed as duodenal invasion from a pancreatic carcinoma In the present case, endoscopic hemostasis with IABO was effective for treatment of duodenal bleedings with life-threatening hemorrhagic shock.