Massive lower gastrointestinal hemorrhage from the surgical anastomosis in patients with multiorgan trauma: treatment by subselective embolization with polyvinyl alcohol particles.
OBJECTIVE
To evaluate the efficacy and safety of subselective arterial embolization with polyvinyl alcohol (PVA) particles with or without microcoil augmentation to control postoperative lower gastrointestinal (GI) bleeding.


METHODS
Ten patients with clinical, scintigraphic, and angiographic evidence of postoperative lower GI bleeding were considered for subselective embolization. Subselective embolizations were performed through coaxial microcatheters with 355-500 micron PVA particles with or without additional coil embolization.


RESULTS
Embolization was technically successful in 9 of 10 (90%) patients. In one patient, subselective embolization was not possible; consequently no embolization was performed. Clinical success was achieved after a single embolization in 6 of 10 (60%) patients and after a second embolization in an additional 3 of the 10 (30%) patients. While there was no rebleeding in patients with normal coagulation parameters, all three patients (100%) with coagulopathy rebled, two of them from another source. Although no acute ischemic effects developed, no long-term sequela such as ischemic stricture were specifically looked for. Seven patients developed abdominal discomfort and/or fever within 24-48 hr. Four of 10 patients died of complications other than hemorrhage or ischemia.


CONCLUSIONS
Subselective PVA embolization with or without a microcoil embolization is an effective and safe means of managing postoperative lower GI hemorrhage in patients with multiorgan trauma.
Bulakbaşi
N
N
Department of Radiology, Gülhane Military Medical Academy, Etlik, 06018 Ankara, Turkey.
Kurtaran
K
K
Ustünsöz
B
B
Somuncu
I
I
D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000601:surgery*; D011142:Polyvinyl Alcohol; D019106:Postoperative Hemorrhage / Q000628:therapy*; D012449:Safety; D016896:Treatment Outcome
D011142:Polyvinyl Alcohol