title: Acute small bowel hemorrhage in three patients with end-stage renal disease: diagnosis and management by angiographic intervention.
abstract: Three patients who had undergone hemodialysis for end-stage renal disease, presented with acute small bowel hemorrhage, and were treated with superselective transcatheter arterial embolization via coaxial microcatheters. In all patients pre-procedure upper gastrointestinal (GI) endoscopy and colonoscopy had failed to demonstrate the source of the hemorrhage. Selective diagnostic angiography revealed frank extravasations of contrast from the small bowel arteries (one jejunal artery and two ileal arteries). After superselection of feeding arteries with a microcatheter, transcatheter embolization using Gelfoam and microcoils was performed in all three patients. Immediate hemostasis was achieved in all patients and the patients were discharged free from symptoms 3-5 days after embolization. No evidence of intestinal ischemia or infarction was noted, with the time from procedure to last follow-up ranging from 4 to 12 months. We conclude that superselective angiography is a valuable tool for diagnosing and treating acute small bowel hemorrhage in patients with end-stage renal disease when endoscopic evaluation has failed.
authors.affiliation: Department of Radiology, Chonnam National University Hospital, 8 Hak-1-dong, Dongku, Gwangju, 501-757, Korea. radyoon@cnuh.chonnam.ac.kr
authors.forename: Woong
authors.initials: W
authors.lastname: Yoon
authors.forename: Jae Kyu
authors.initials: JK
authors.lastname: Kim
authors.forename: Heoung Kil
authors.initials: HK
authors.lastname: Kim
authors.forename: Young Min
authors.initials: YM
authors.lastname: Han
authors.forename: Heoung Keun
authors.initials: HK
authors.lastname: Kang
mesh_terms: D000208:Acute Disease; D000368:Aged; D000792:Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome