Abstract
The efficacy of emergent embolotherapy was evaluated in six patients suffering hemorrhage from the small intestine. Hemorrhage was from the jejunum in four patients, from the ileum in one, and from Meckel's diverticulum in one. Superselective embolization of the arcade of the small intestine artery branch was performed in all patients with a coaxial catheter. Embolic materials used were Gelfoam particles alone or Gelfoam particles plus coils in earlier cases and microcoils in recent cases. Complete hemostasis was immediately achieved in all patients, but one patient died of disseminated intravascular coagulation. After stabilization of the patient's condition by hemostasis, elective surgery was performed on three patients suffering small intestine ulcer. Histopathologically, no bowel infarction was noted but mild mucosal inflammation with submucosal edema was found in the jejunum of two patients. We recommend embolization for life-threatening small intestine hemorrhage, preferentially in situations where the blood vessel involved can be superselectively occluded at the nearest level of the arcade of the vasa recta, lest the vasa recta should be occluded.
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References
Rösch J, Kozak BE, Keller FS. Interventional diagnostic angiography in acute lower-gastrointestinal bleeding.Semin Intervent Radiol 1988;5:10–17
Uflacker R. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding.Acta Radiol 1987;28:425–430
Gomes AS, Lois JF, McCoy RD. Angiographic treatment of gastrointestinal hemorrhage. Comparison of vasopressin infusion and embolization.AJR 1986;146:1031–1037
Baum S, Rösch J, Dotter C. Selective mesenteric arterial infusions in the management of massive diverticular hemorrhage.N Engl J Med 1973;288:1269–1272
Sebrechts C, Bookstein JJ. Embolization in the management of lower-gastrointestinal hemorrhage.Semin Intervent Radiol 1988;5:39–48
Walter WJ, Goldin AR, Shaff MI, Allibone GW. Per catheter control of haemorrhage from the superior and inferior mesenteric arteries.Clin Radiol 1980;31:71–80
Palmaz JC, Walter JF, Cho KJ. Therapeutic embolization of the small-bowel arteries.Radiology 1984;152:377–382
Tillotson CL, Geller SC, Kantrowitz L, Eckstein MR, Waltman AC, Athanasoulis CA. Small bowel hemorrhage. Angiographic localization and intervention.Gastrointest Radiol 1988;13:207–211
Okazaki M, Higashihara H, Yamasaki S, Akita Y, Toriya H, Shirai Z. Arterial embolization to control life-threatening hemorrhage from a Meckel's diverticulum.AJR 1990;154:1257–1258
Alavi A, Ring E. Localization of gastrointestinal bleeding. Superiority of technetium sulfur colloid compared with angiography.AJR 1981;137:741–748
Rollins ES, Picus D, Hicks ME, Darcy MD, Bower BL, Kleinhoffer MA. Angiography is useful in detecting the source of chronic gastrointestinal bleeding of obscure origin.AJR 1991;156:385–388
Briley CA, Jackson DC, Johnsrude IS, Mills SR. Acute gastrointestinal hemorrhage of small-bowel origin.Radiology 1980;136:317–319
Athanasoulis CA, Moncure AC, Greenfield AJ, Ryan JA, Dodson TF. Intraoperative localization of small bowel bleeding sites with combined use of angiographic methods and methylene blue injection.Surgery 1980;87:77–84
Chalmers AG, Robinson PJ, Chapman AH. Embolisation in small bowel haemorrhage.Clin Radiol 1986;37:379–381
Taylor FW, Epstein LI. Treatment of massive diverticular hemorrhage.Arch Surg 1969;98:505–508
Behringer GE, Albright NL. Diverticular disease of the colon. A frequent cause of massive rectal bleeding.Am J Surg 1973;125:419–423
Rahn NH, Tishler JM, Han SY, Russinovich NAE. Diagnostic and interventional angiography in acute gastrointestinal hemorrhage.Radiology 1982;143:361–366
Bookstein JJ, Chlosta EM, Foley D, Walter JF. Transcatheter hemostasis of gastrointestinal bleeding using modified autogenous clot.Radiology 1974;113:277–285
Jander HP, Russinovich NAE. Transcatheter gelfoam embolization in abdominal, retroperitoneal, and pelvic hemorrhage.Radiology 1980;136:337–344
Clark RA, Colley DP, Eggers FM. Acute arterial gastrointestinal hemorrhage. Efficacy of transcatheter control.AJR 1981;136:1185–1189
Ross JA. Vascular patterns of small and large intestine compared.Br J Surg 1952;39:330–333
Cho KJ, Schmidt RW, Lenz J. Effects of experimental embolization of superior mesenteric artery branch of the intestine.Invest Radiol 1979;14:207–212
Noer RJ. The blood vessels of the jejunum and ileum: a comparative study of man and certain laboratory animals.Am J Anat 1943;73:293–334
Goldberger LE, Bookstein JJ. Transcatheter embolization for treatment of diverticular hemorrhage.Radiology 1977;122:613–617
Meyerovits MF, Levin DC, Boxt LM. Superselective catheterization of small-caliber arteries with a new high-visibility steerable guide wire.AJR 1985;144:785–786
Okazaki M, Ono H, Higashihara H, Koganemaru F, Nozaki Y, Hoashi T, Kimura T, Yamasaki S, Makuuchi M. Angiographic management of massive hemobilia due to iatrogenic trauma.Gastrointest Radiol 1991;16:205–211
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Okazaki, M., Furui, S., Higashihara, H. et al. Emergent embolotherapy of small intestine hemorrhage. Gastrointest Radiol 17, 223–228 (1992). https://doi.org/10.1007/BF01888554
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DOI: https://doi.org/10.1007/BF01888554