Lower gastrointestinal bleeding treated with transcatheter arterial embolization. Case report and review of the literature.
Acute lower gastrointestinal bleeding, is often a dramatic situation, associated with mortality rate up to 28%. Currently transcatheter alternatives have found their place in the therapeutic spectrum of this situation. An interesting question is when should this procedure be performed and which are the difficulties when performing it. We present the case of a 75-year old woman with acute massive lower gastrointestinal bleeding on the tenth post-operative day of a colic and partial ileal resection. Superselective angiography of the superior mesenteric artery was obtained that disclosed marked contrast extravasation of distal branches of the left colic artery as well as from a small branch feeding the distal enteric anastomoses. Clinical success was achieved after superselective embolization which was accomplished by using polyvinyl alcohol particles. The patient was discharged 5 days later and there were no procedure-related complications during 6-month follow-up period. So, especially in post-operative patients who are considered to be poor candidates for surgical treatment, arterial embolotherapy should be established not only as treatment option, but also as first line therapy for LGI bleeding.
Pomoni
Maria
M
Research Unit of Radiology and Imaging Eugenidion University Hospital of Athens, Greece. mpomoni@mail.gr
Sissopoulos
Athanasios
A
Condilis
Nicolas
N
Pomoni
Anastasia
A
Chalazonitis
Athanasios N
AN
Vasileiou
Ioanna
I
Ptohis
Nikolaos
N
Kelekis
Dimitrios A
DA
D000208:Acute Disease; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000792:Angiography; D002404:Catheterization; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D011142:Polyvinyl Alcohol / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage / Q000628:therapy; D013997:Time Factors
D011142:Polyvinyl Alcohol