Control of postoperative renal hemorrhage by embolization with a Gianturco coil

A 35-year-old woman underwent a left pyelonephrolithotomy for removal of a staghorn calculus. Blood loss was minimal for 5 days. Then there was profuse bleeding from the left kidney that did not respond to conservative management. Angiographic examination demonstrated extravasation of contrast medium from a minor intrarenal artery in the lower pole of the kidney directly into the pelvicalyceal system. An attempt was made to embolize the bleeding vessel with Gelfoam particles but this failed because the Gelfoam passed directly into the collecting system. A Gianturco coil, however, occluded the vessel and immediately the hemorrhage ceased; the patient had no further complications. The authors emphasize that the introduction of a steel coil to control bleeding is advocated only when the use of temporary occlusive agents is unsuccessful.