Delayed Life‐Threatening Thyroid Artery Hemorrhage After Percutaneous Transesophageal Gastro‐Tubing in Amyotrophic Lateral Sclerosis: A Case Report

ABSTRACT Percutaneous transesophageal gastro‐tubing provides enteral access when endoscopic gastrostomy is not feasible, but delayed vascular injury is seldom reported. We describe a 73‐year‐old woman with amyotrophic lateral sclerosis and prior gastrectomy who became ventilator‐dependent and underwent percutaneous transesophageal gastro‐tubing. More than 1 year later, she developed recurrent cervical bleeding that progressed to massive pulsatile hemorrhage requiring transfusion. Contrast‐enhanced computed tomography showed the tract abutting the thyroid gland, whereas catheter angiography identified a pseudoaneurysm of the left thyroid artery. Selective transarterial embolization with coils and n‐butyl cyanoacrylate achieved definitive hemostasis without recurrence. Re‐insertion of percutaneous transesophageal gastro‐tubing was avoided, and nutrition was maintained via a nasoenteric tube and a central venous port. This case highlights thyroid artery hemorrhage as a potentially fatal, delayed complication of long‐term percutaneous transesophageal gastro‐tubing in amyotrophic lateral sclerosis. We emphasize optimal preprocedural planning, prevention, and a rapid, appropriate response to bleeding.