A Rare Complication in the Treatment of Gastrointestinal Bleeding via Superselective Embolization: A Case Report

Case Report

Austin J Radiol. 2015;2(2): 1013.

A Rare Complication in the Treatment of Gastrointestinal Bleeding via Superselective Embolization: A Case Report

Cetinkaya OA1, Konca C1, Kocaay F1, Peker A2 and Akyol C1*

1Ankara University, Department of General Surgery, Turkey

2Ankara University, Department of Radiology, Turkey

*Corresponding author: Cihangir Akyol, Ankara University, Faculty of Medicine, Department of General Surgery, Division of Colorectal Surgery, 06100, Sihhiye, Ankara, Turkey

Received: December 10, 2014; Accepted: February 24, 2015; Published: February 27, 2015


Acute lower Gastrointestinal (GI) bleeding is conventionally determined as a bleeding occured from a distal part of the ligament of Treitz. The bleeding stops spontaneously in most of the cases, and the mortality rate is reported as 2 to 4%. In the treatment of GI bleeding, local endovascular vasoconstrictive therapy, thermal cautery or bipolar injection delivered via an endoscope, and surgical resection are accepted as popular modalities. Superselective Mesenteric embolization (SME) has rapidly gaining acceptance as a treatment option for severe intestinal hemorrhage, especially for the patients with comorbidities. Surgical resection is still an option for the cases of severe bleeding but peroperative morbidity and mortality rates are higher in the patients with co-morbidities. Superiority of SME to vasopressin infusion is reported as the success of the durability of the bleeding. In superselective embolization series, clinical success ranged from 44% to 91% and major ischemic complications ranged from 0% to 6%. Enthusiasm for this technique continues to grow due to its inherent advantages as compared with vasopressin infusion. With the embolization, bleeding is stopped at the time of the procedure without a prolonged infusion or multi-angiograms.

We report here a case of a colonic bleeding treated by superselective embolization, but underwent surgery due to a complication of mesenteric ischemia.

Keywords: Gastrointestinal bleeding; Embolization; Acute ischemia

Case Report

A 75-year-old male patient with type 2 diabetes mellitus and gallbladder neoplasia, admitted to our hospital with a complaint of spontaneous rectal bleeding consisting for 48 hours which occured only between 1 a.m. and 3 a.m.. Vital signs were found normal at the time of the administration. Hemoglobin level was 10,3 g/dL and hematocrit was %31,7. The patient hospitalized and observed for 2 days with a conservative management. In that period, he had recurrent hematochezia and needed two units (approximately 500 mL) of blood transfusion. Colonoscopy could not reveal the origin of the bleeding because of the colon was full of blood. There was no sign of hemorrhage in the upper GI endoscopy. A computerized tomographic angiogram was performed and the only pathologic finding was diverticulosis about the intestinal system without any proof of bleeding. In the need for ongoing blood transfusion and the unsuccessful endoscopic procuderes indicated for a digital substraction angiogram to diagnose and treat the problem. Bleeding could not be seen in the selective canulation of superior mesenteric and inferior mesenteric arteries (Figure 1). A negative colonoscopy was performed afterwards and the patient observed for that day. Massive bleeding attacks repeated at midnight and therefore conventional angiography was reperformed simultaneously. An extravasation originated from the distal branches of the right colic and the middle colic arteries was determined in our case. Embolization of the distal branches of the right colic artery was successfully done with the Polyvinyl Alcohol (PVA) molecules of 355-500 microns; however the middle colic artery could not be catheterized superselectively because of the angulation at the branching level and PVA was performed at this level (Figure 2). At the control angiogram, no signs of bleeding was determined (Figure 3).