Use of provocative angiography to localize site in recurrent gastrointestinal bleeding.
BACKGROUND
While the source of most cases of lower gastrointestinal bleeding may be diagnosed with modern radiological and endoscopic techniques, approximately 5% of patients remain who have negative endoscopic and radiological investigations [1].


OBJECTIVE
These patients require repeated hospital admissions and blood transfusions, and may proceed to exploratory laparotomy and intraoperative endoscopy. The personal and financial costs are significant.
The technique of adding pharmacologic agents (anticoagulants, vasodilators, fibrinolytics) during standard angiographic protocols to induce a prohemorrhagic state is termed provocative angiography. It is best employed when significant bleeding would otherwise necessitate emergency surgery.


METHODS
This practice frequently identifies a bleeding source (reported success rates range from 29 to 80%), which may then be treated at the same session. We report the case of a patient with chronic lower gastrointestinal hemorrhage with consistently negative endoscopic and radiological workup, who had an occult source of bleeding identified only after a provocative angiographic protocol was instituted, and who underwent succeeding therapeutic coil embolization of the bleeding vessel.
Johnston
Ciaran
C
Department of Radiology, St. James' Hospital, Dublin 8, Ireland. ciaranjohnston@yahoo.co.uk
Tuite
David
D
Pritchard
Ruth
R
Reynolds
John
J
McEniff
Niall
N
Ryan
J Mark
JM
D000792:Angiography / Q000379:methods*; D000925:Anticoagulants; D003108:Colonic Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D004621:Embolization, Therapeutic; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006493:Heparin; D006801:Humans; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008875:Middle Aged; D009780:Occult Blood; D010208:Papaverine; D012008:Recurrence; D010959:Tissue Plasminogen Activator; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014665:Vasodilator Agents; D006493:Heparin; D010208:Papaverine; D010959:Tissue Plasminogen Activator