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Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results.

Abstract：

BACKGROUND:Lower gastrointestinal bleeding represents 20 % of all gastrointestinal bleedings. Interventional radiology has transformed the treatment of this pathology, but the long-term outcome after selective embolization has been poorly evaluated. The aim of this study is thus to evaluate the short-term and long-term outcomes after selective embolization for colonic bleeding. METHODS:From November 1998 to December 2010, all acute colonic embolizations for hemorrhage were retrospectively reviewed and analyzed. The risk factors for post-embolization ischemia were also assessed. RESULTS:Twenty-four patients underwent colonic embolization. There were 6 men and 18 women with a median age of 80 years (range, 42-94 years). The underlying etiologies included diverticular disease (41.9 %), post-polypectomy bleeding (16.7 %), malignancy (8.2 %), hemorrhoid (4.1 %), and angiodysplasia (4.1 %). In 23 patients, bleeding stopped (95.8 %) after selective embolization. One patient presented a recurrence of bleeding with hemorrhagic shock and required urgent hemorrhoidal ligature. Four patients required an emergent surgical procedure because of an ischemic event (16.7 %). One patient died of ileal ischemia (mortality, 4.1 %). The level of embolization and the length of hypoperfused colon after embolization were the only risk factors for emergent operation. Mean hospital stay was 18 days (range, 9-44 days). After a mean follow-up of 28.6 months (range, 4-108 months), no other ischemic events occurred. CONCLUSION:In our series, selective transarterial embolization for acute colonic bleeding was clinically effective with a 21 % risk of bowel ischemia. The level of embolization and the length of the hypoperfused colon after embolization should be taken into consideration for emergent operation.

journal_name

Int J Colorectal Dis

journal_title

International journal of colorectal disease

authors

Rossetti A,Buchs NC,Breguet R,Bucher P,Terraz S,Morel P

doi

10.1007/s00384-012-1621-5

subject

Has Abstract

pub_date

2013-06-01 00:00:00

pages

777-82

issue

eissn

0179-1958

issn

1432-1262

journal_volume

pub_type

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Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results.