Selective angiography for diagnosis and treatment for intestinal bleeding

Abstract

In case of intestinal bleeding, selective angiography is very informative to detect the cause of bleeding and the site of bleeding. Major diseases examined were ischemic lesions of intestine diverticulosis, myogenic tumors, and severe cases of ulcerative colitis. Operations were carried out when indicated. To the rest of the cases interventional angiography was carried out. Interventional angiography for intestinal bleeding was performed to 52 cases inclusive of 9 cases of bleeding from the tumor, 2 cases of diverticulosis, 3 cases of intestinal Behcet and 28 cases of severe ulcerative colitis. Administered drugs were continuous perfusion of vasopressin to the ruptured vessels and water-soluble bolus intraarterial injection of prednisolone to the inflammatory process of ulcerative colitis. All the vasopressin cases were responded to this therapy. Efficacy of intraarterial injection of prednisolone was evaluated in 56 cases including the cases of cooperative study group. Efficacy was compared to the 5 days intensive intravenous therapy, revealing the similar response rate. It was also reported that seven cases to which the 5 days intensive therapy was ineffective responded to intraarterial injection therapy. Mechanism of intraarterial injection therapy was studied by analyzing the pre and post angiographical findings and by measuring mucosal blood flow and oxygen saturation. Administered high dose of prednisolone may improve the microcirculation. Further studies were indicated.