Pseudoaneurysm embolization and vasopressin infusion for lower gastrointestinal bleeding due to recurrence of urinary bladder carcinoma.
We report a case that was successfully treated for massive lower gastrointestinal (LGI) bleeding due to a recurrent urinary bladder carcinoma. Treatment consisted of combination therapy including embolization of an inferior gluteal artery (IGA) pseudoaneurysm and low-dose arterial vasopressin infusion via a sigmoid artery (SA). A 57-year-old man presented with life-threatening sudden, massive LGI bleeding due to an obturator lymph node (LN) metastasis from a urinary bladder carcinoma. Computed tomography showed that the LN recurrence had invaded all the way to the sigmoid colon, and there was a pseudoaneurysm with extravasation inside the recurrence. An angiogram revealed a left IGA pseudoaneurysm. We therefore excluded the pseudoaneurysm by embolization with microcoils. Following this treatment the bleeding decreased, but intermittent LGI bleeding continued. Endoscopic examination showed the tumor with a huge ulcer inside the colonic lumen, and continuous oozing was confirmed. A second angiogram showed no recurrence of the IGA pseudoaneurysm and no apparent findings of bleeding. Then a 3F microcatheter was placed in the SA selectively using a coaxial catheter system, and vasopressin was infused at a rate 0.05 U/min for 12 h. Bleeding completely ceased 2 days later. There were no signs of ischemic gastrointestinal complications. Massive LGI bleeding has not recurred in 5 months.
Kakizawa
Hideaki
H
Department of Radiology, Hiroshima University Hospital, Hiroshima, Japan. kakizawa@hiroshima-u.ac.jp
Toyota
Naoyuki
N
Mita
Koji
K
Fujimura
Yoshio
Y
Hieda
Masashi
M
Hirai
Nobuhiko
N
Tachikake
Toshihiro
T
Ito
Katsuhide
K
D017541:Aneurysm, False / Q000209:etiology* / Q000628:therapy*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications* / Q000628:therapy; D012008:Recurrence; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000628:therapy; D014667:Vasopressins / Q000008:administration & dosage*
D006490:Hemostatics; D014667:Vasopressins