title: Preoperative superselective mesenteric angiography and methylene blue injection for localization of obscure gastrointestinal bleeding.
abstract: Localizing obscure gastrointestinal bleeding can be a clinical challenge, despite the availability of various endoscopic, imaging, and visceral angiographic techniques. We reviewed the management of patients presenting with obscure gastrointestinal bleeding during the period from 2005 to 2011. Four patients had preoperative localization of the bleeding site with superselective mesenteric angiography, which was confirmed by the use of intraoperative methylene blue injection. This novel technique allowed us to identify the abnormal pathology, and, consequently, resection of the implicated segment of small bowel was performed without any postoperative complications. Final histology showed that 2 patients had arteriovenous malformations: one had a benign hemangioma of the small bowel, and the other had chronic ischemic ulceration in the ileum. Superselective mesenteric angiography combined with intraoperative localization with methylene blue is an important and innovative technique in the management of patients with unclear sources of gastrointestinal bleeding and allows for effective hemorrhage control with a focused and therefore limited bowel resection.
authors.affiliation: Hepatopancreaticobiliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Healthcare NHS Trust, Hammersmith Hospital, London, England.
authors.forename: Madhava
authors.initials: M
authors.lastname: Pai
authors.forename: Adam E
authors.initials: AE
authors.lastname: Frampton
authors.forename: Jagdeep S
authors.initials: JS
authors.lastname: Virk
authors.forename: Nyooti
authors.initials: N
authors.lastname: Nehru
authors.forename: Charis
authors.initials: C
authors.lastname: Kyriakides
authors.forename: Paolo
authors.initials: P
authors.lastname: Limongelli
authors.forename: James E
authors.initials: JE
authors.lastname: Jackson
authors.forename: Long R
authors.initials: LR
authors.lastname: Jiao
mesh_terms: D000368:Aged; D001165:Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D004791:Enzyme Inhibitors; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D006391:Hemangioma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging*; D008751:Methylene Blue; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D011300:Preoperative Care; D015641:Radiography, Interventional / Q000379:methods*
chemical_list: D004791:Enzyme Inhibitors; D008751:Methylene Blue