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FRASER HEALTH AUTHORITY Signed
Royal Columbian Hospital Medical Imaging Report

ACCOUNT#: RC404198/21 UNIT #: RC03030788

PHN: 9128549738 NAME: HOLAND,MARK THOMAS
PT.TEL#: (236)994-3376 AGE: 43 SEX:M

DOB: 04/09/1978 REG CAT: RC.ACU LOC: RC-ERIN1
ADMIT: 08/03/22 DISCHARGE:

Order Dr: Atkinson,Kenneth A; Koehn,Martha; Ng,Pearily P_ Family Dr: Dasanjh,Nikhilesh
Attend Dr: CTU-RED Dictate Dr: Best,Andrew

EXAM DATE:08/03/22 PACS ID#:RC767065 BCCA#:

ORDERS: REPORT#:0803-3762

0803-0125 RADS/US Guidance for Puncture Abdo; 0803-0130 RADS/Embolization; 0803-0153 RADS/Angio
Select for Embolization; 0803-0154 RADS/Angio Select for Embolization; 0803-0155 RADS/Angio Select for
Embolization; 0803-0156 RADS/Angio Select for Embolization; 0803-0157 RADS/Angio Select for
Embolization; 0803-0158 RADS/Angio Select for Embolization

EXAM TYPE:
RADS Embolization; RADS Angio Select for Embolization, RADS US Guidance for Puncture Abdo

HISTORY:

Actively bleeding duodenal ulcer in an unstable patient in the Emergency Department. Attempt at endoscopic
control was unsuccessful, but endoscopic clips have been placed at the site of bleeding to facilitate the
requested urgent IR embolization.

COMPARISON:
There is no previous relevant imaging.

FLUOROSCOPY TIME:
32 minutes and 30 seconds.

MEDICATIONS:
1 mg IV Versed and 75 mcg IV fentanyl.

PROCEDURE:

Abbreviated verbal consent was obtained given the urgency of the situation. 2 units of packed red blood cells
were administered in the Emergency Department. Dr. Koehn from the Emergency Department attended at the
beginning of the procedure as there was concern the patient may be further hemodynamically unstable.

From the start to the end of the procedure, however the patient remained completely hemodynamically stable.
The right groin was prepped and draped in a sterile manner. Following local anesthesia with 1% lidocaine,
under direct ultrasound visualization a micropuncture needle was used to access the right common femoral
artery. A §-French sheath was placed. A 5-French Cobra catheter was used to select the superior mesenteric
artery. Superior mesenteric angiography was performed both as a hand injection, and as power injection.

It was immediately apparent that the patient had complex anatomy related to chronic high grade stenosis or
occlusion at the origin of the celiac axis. A markedly enlarged branch of the SMA continues to the left of
midline and there is a network of markedly enlarged pancreaticoduodenal arteries that converge toward the

RC03030788 - HOLAND,MARK THOMAS
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