The changing paradigm for the treatment of colonic hemorrhage: superselective angiographic embolization.

Abstract

Colonic bleeding has historically been controlled by the use of localization procedures and surgery. Since our initial experience with superselective embolization of colonic bleeding, it has become our preferred method for the control of lower gastrointestinal hemorrhage. This follow-up study evaluates the Hartford Hospital experience using angiographic methods as the primary modality for the treatment of colonic bleeding. From March 1993 to September 1999, 27 patients who had angiographically visualized colonic hemorrhage underwent arterial embolization procedures. Diagnostic arteriography was performed in all patients using digital subtraction imaging and selective contrast injections into the superior and inferior mesenteric arteries. Once the bleeding site was identified, superselective arteriogram and embolization was performed. Platinum-fibered coils, Hilal coils, or polyvinyl alcohol particle emboli were then fluoroscopically guided into the bleeding vessel. A repeat arteriogram was performed to confirm occlusion and the absence of any collateral channels. All 27 patients were initially controlled with arterial embolization; 6 patients rebled (22.2 percent), and 5 of these patients required surgery. Two patients demonstrated ischemia (7.4 percent), one of which required surgical intervention. The other patient was followed up by colonoscopy. There was no mortality in this study. Superselective embolization is effective in controlling colonic hemorrhage and is associated with a low rate of postembolization ischemia. Our experience with angiography reinforces the paradigm shift from its use as a diagnostic tool to the primary method for the control of colonic bleeding. Because patients have been followed up for as long as seven years, this approach remains effective for the long-term treatment of colonic bleeding.