Lower gastrointestinal haemorrhage and superselective angiographic embolization.

BACKGROUND: Little information is available in the surgical literature regarding the use of superselective embolization for bleeding with its origin distal to the ligament of Treitz. The outcome of this treatment remains, to some extent, an unknown. The present paper evaluates the Alfred Hospital's experience using superselective transcatheter embolization in the treatment of acute lower gastrointestinal haemorrhage.
METHODS: An uncontrolled case series analysis was undertaken of all 15 patients who underwent arterial embolization for lower gastrointestinal bleeding, defined as distal to the ligament of Treitz, from July 1998 to January 2003 at the Alfred Hospital, Victoria.
RESULTS: Transcatheter embolization achieved satisfactory haemostasis in 14 out of 15 patients (93%). Eight patients had rebleeding within 24 h of the initial procedure (53.3%). Two groups of patients emerged: 10 patients who had active bleeding identified on angiography (67%) and five patients whose angiograms failed to find an active bleeding site (33%). Ten per cent of patients with active bleeding observed on angiogram developed bowel ischaemia and 20% died from ischaemia or continued bleeding. Patients without active bleeding identified at the time of angiogram had a proven ischaemia rate of 60% and a 60% mortality rate from continued bleeding or intestinal ischaemia.
CONCLUSION: High-risk patients, with active bleeding identified on angiography, can be successfully treated by superselective angiographic embolization and this appears to be an acceptable alternative to emergency resection. If active bleeding is not identified angiographically embolization is not recommended.