Super-Selective Mesenteric Embolization as Guide for Surgical Resection in Bleeding Small Bowel Angiodysplasia

Abstract

We present the case of a 79-year-old woman and of a 43-year-old man with no relevant past medical history. Both patients were admitted to the emergency department for anemia and rectal bleeding. After resuscitation, the two patients underwent colonoscopy and gastroscopy, both negative. Computed tomography angiography revealed active bleeding from the small bowel in both cases. The first patient underwent angiography and mesenteric embolization with surgical glue, obtaining a complete stop of the bleeding. After 2 days, a small bowel resection was performed under the guidance of the segmental bowel ischemia secondary to embolization. In the second patient, the angiography revealed a large jejunal angiodysplasia. Therefore, a mesenteric super-selective embolization was carried out. The intraoperative identification of the coils allowed to guide the following bowel resection. The postoperative course was uneventful in both patients. Small bowel angiodysplasia is a rare cause of lower gastrointestinal bleeding. In most patients, bleeding stops spontaneously. However, patients with ongoing active bleeding non-responding to conservative treatment may need invasive procedures. The use of super-selective mesenteric embolization is highly successful and relatively safe. When surgery is necessary, identification of the bleeding site is troublesome. In this setting, angioembolization could help to identify the correct site of bleeding, thus allowing to perform a segmental small bowel resection.