Postembolization small bowel ischaemia

Abstract

A 28-year-old man presented with massive gastrointestinal aemorrhage and hypovolemic shock. His haemoglobin level ropped to 5 g/dl over a six-hour period. Emergency upper ndoscopy to the second part of the duodenum showed no bnormalities. Digital subtraction visceral angiography was perormed. Superior mesenteric arteriography revealed bleeding from marginal branch of the ileocolic artery (Fig. 1A, arrow) that suplied the distal ileum, consistent with small bowel angiodysplasia. uperselective mesenteric embolization with gelatin sponges was erformed (Fig. 1B, arrow). Twelve hours after this procedure, the patient complained f crampy abdominal pain in the lower quadrants. On physial examination, the abdomen was tender and diffusely tense. aboratory findings revealed increased levels of lactate dehydroenase (1065 IU/L), hematocrit (75%) and neutrophil granulocytes 17.220 mm−3). Under the suspicion of intestinal ischaemia, an exploratory aparotomy was performed, and a 5 cm ischaemic ileal loop was ound and resected (Fig. 2). The patient recovered uneventfully and was discharged on postperative day 4. Small bowel ischaemia represents a rare side effect after uperselective mesenteric embolization in patients with acute gasrointestinal bleeding, 3% according to the most recent series [1].