title: Aberrant celio-mesenteric supply of the splenic flexure: provoking a bleed.
abstract: Lower gastrointestinal hemorrhage presents a common indication for hospitalization and account for over 300,000 admissions per year in the United States. Multimodality imaging is often required to aid in localization of the hemorrhage prior to therapeutic intervention if endoscopic treatment fails. Imaging includes computer tomography angiography, red blood cell tagged scintigraphy and conventional angiography, with scintigraphy being the most sensitive followed by computer tomography angiography. Aberrant celio-mesenteric supply occurs in 2% of the population; however failure to identify this may result in failed endovascular therapy. Computer tomography angiography is sensitive for arterial hemorrhage and delineates the anatomy, allowing the treating physician to plan an endovascular approach. If at the time of conventional angiography, the active bleed is not visualized, but the site of bleeding has been identified on computer tomography angiography, provocative angiography can be utilized in order to stimulate bleeding and subsequent targeted treatment. We describe a case of lower gastrointestinal hemorrhage at the splenic flexure supplied by a celio-mesenteric branch in a patient and provocative angiography with tissue plasminogen activator utilized at the time of treatment to illicit the site of hemorrhage and subsequent treatment.
authors.affiliation: Matthew Wu, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wu
authors.forename: Darren
authors.initials: D
authors.lastname: Klass
authors.forename: Evgeny
authors.initials: E
authors.lastname: Strovski
authors.forename: Baljinder
authors.initials: B
authors.lastname: Salh
authors.forename: David
authors.initials: D
authors.lastname: Liu
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D002445:Celiac Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D044684:Colon, Transverse / Q000098:blood supply*; D004621:Embolization, Therapeutic; D005260:Female; D005343:Fibrinolytic Agents; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008638:Mesenteric Arteries / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D010959:Tissue Plasminogen Activator; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Colon transverse; Computer tomography; Embolization therapeutic; Hemorrhage; Mesenteric arteries; Thrombolytic therapy