The efficacy of selective arterial embolization in the management of colonic bleeding
S Adusumilli1, M P Gosselink, G Ctercteko
1Westmead Hospital, Sydney, NSW, Australia, sadu1@hotmail.com.
Insights
Mesenteric embolization effectively stops acute colonic bleeding in most patients. However, 18% rebleed, and 20% experience complications, with surgery significantly increasing risks.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Vascular Surgery
Background:
- Acute colonic hemorrhage presents a significant clinical challenge.
- Mesenteric embolization is a potential therapeutic option.
Purpose of the Study:
- To evaluate the efficacy and safety of mesenteric embolization for acute colonic bleeding.
Main Methods:
- Retrospective review of 71 patients undergoing selective arterial embolization (2002-2010).
- Analysis included patient history, procedural details, and recovery outcomes.
Main Results:
- 86% of patients achieved immediate hemostasis.
- 20% experienced procedure-related morbidity (renal dysfunction, hematoma, allergy).
- 18% had recurrent bleeding; 5 required repeat embolization, 5 underwent surgery with increased complications.
Conclusions:
- Mesenteric embolization is a successful treatment for most colonic bleeding cases, with low rates of ischemia.
- Significant rates of rebleeding and procedure-related complications necessitate careful patient selection and monitoring.
- Surgical intervention after embolization is associated with dramatically increased morbidity and mortality.
Background:
The aim of the present study was to determine the efficacy of mesenteric embolization in the management of acute haemorrhage from the colon.
Methods:
A retrospective review was performed of a consecutive series of patients who underwent selective arterial embolization between 2002 and 2010 at two Australian institutions. An analysis was performed of each patient's present and past medical history, procedural details and subsequent post-procedural recovery.
Results:
Seventy-one patients were reviewed in the study. Sixty-one patients (86 %) had immediate cessation of bleeding following embolization. In total, 20 % had some form of morbidity due to mesenteric embolization being performed, the three most common being worsening renal function, groin haematoma and contrast allergy (11, 9 and 7 %, respectively). Only one patient developed superficial bowel ischaemia. Overall, 11 patients (18 %) had recurrent bleeding. Of these patients, five had repeat embolization. Of the patients who underwent re-embolization, three stopped bleeding. Surgery was required in 5 patients 2 of whom died postoperatively of systemic complications.
Conclusions:
Colonic bleeding can be treated successfully in most patients by embolization, without causing ischaemia. Eighteen per cent of patients rebleed during the first hospital admission, and 20 % patients experienced a procedure-related complication. In those patients that proceed to surgery, the morbidity, mortality and length of hospital stay increase dramatically.
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