Ann Coloproctol.  2013 Oct;29(5):205-208. 10.3393/ac.2013.29.5.205.

The Safety and Efficacy of Mesenteric Embolization in the Management of Acute Lower Gastrointestinal Hemorrhage

Affiliations
  • 1Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia. cyoungnsw@aol.com
  • 2Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia.

Abstract

PURPOSE
Mesenteric embolization is an integral part in the management of acute lower gastrointestinal (GI) bleeding. The aim of this study was to highlight our experience after adopting mesenteric embolization in the management of acute lower GI hemorrhage.
METHODS
A retrospective review of all cases of mesenteric embolization for acute lower GI bleeding from October 2007 to August 2012 was performed.
RESULTS
Twenty-seven patients with a median age of 73 years (range, 31 to 86 years) formed the study group. More than half (n = 16, 59.3%) of the patients were on either antiplatelet and/or anticoagulant therapy. The underlying etiology included diverticular disease (n = 9), neoplasms (n = 5) and postprocedural complications (n = 6). The colon was the most common bleeding site and was seen in 21 patients (left, 10; right, 11). The median hemoglobin prior to the embolization was 8.6 g/dL (6.1 to 12.6 g/dL). A 100% technical success rate with immediate cessation of hemorrhage at the end of the session was achieved. There were three clinical failures (11.1%) in our series. Two patients re-bled, and both underwent a successful repeat embolization. The only patient who developed an infarcted bowel following embolization underwent an emergency operation and died one week later. There were no factors that predicted clinical failure.
CONCLUSION
Mesenteric embolization for acute lower GI bleeding can be safely performed and is associated with a high clinical success rate in most patients. A repeat embolization can be considered in selected cases, but postembolization ischemia is associated with bad outcomes.

Keyword

Bleeding; Embolization; Lower; Gastrointestinal

MeSH Terms

Colon
Emergencies
Gastrointestinal Hemorrhage*
Hemoglobins
Hemorrhage
Humans
Ischemia
Retrospective Studies
Hemoglobins
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