ORIGINAL ARTICLE PURPOSE We aimed to evaluate the outcomes of coil embolization of true visceral artery aneurysms by three-dimensional contrast-enhanced magnetic resonance (MR) angiography. MATERIALS AND METHODSWe used three-dimensional contrast-enhanced MR angiography, which included source images, to evaluate 23 patients (mean age, 60 years; range, 28-83 years) with true visceral artery aneurysms (splenic, n=15; hepatic, n=2; gastroduodenal, n=2; celiac, n=2; pancreaticoduodenal, n=1; gastroepiploic, n=1) who underwent coil embolization. Angiographic aneurysmal occlusion was revealed in all cases. Follow-up MR angiography was conducted with either a 1.5 or 3 Tesla system 3-25 months (mean, 18 months) after embolization. MR angiography was evaluated for aneurysmal occlusion, hemodynamic status, and complications. RESULTSComplete aneurysmal occlusion was determined in 22 patients (96%) on follow-up MR angiography (mean follow-up period, 18 months). Neck recanalization, which was observed at nine and 20 months after embolization, was confirmed in one of eight patients (13%) using a neck preservation technique. In this patient, a small neck recanalization covered by a coil mass was demonstrated. The complete hemodynamic status after embolization was determined in 21 patients (91%); the visualization of several collateral vessels, such as short gastric arteries, after parent artery occlusion was poor compared with that seen on digital subtraction angiography in the remaining two patients (9%). An asymptomatic localized splenic infarction was confirmed in one patient (4%). CONCLUSIONOur study presents the follow-up results from three-dimensional contrast-enhanced MR angiography, which confirmed neck recanalization, the approximate hemodynamic status, and complications. This effective and less invasive method may be suitable for serial follow-up after coil embolization of true visceral aneurysms.

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Postpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.

DESCRIPTIONA 59-year-old man with no history of abdominal or intestinal surgery, trauma or psychiatric illness presented to our hospital with abdominal pain and vomiting. Physical examination revealed hyperactive bowel sounds and lower abdominal tenderness. Abdominal CT revealed a small bowel obstruction in the lower abdominal space, possibly due to obstruction of the fusiform low attenuation (-162 Hounsfield units) region (figure 1, arrows), and suspected ileal stricture on the anal side of the low-attenuation region. The region was similar to that of fat to air attenuation. Insertion of a nasogastric tube did not improve his condition, blood pressure decreased, and his symptoms were ingravescent. Emergency surgery was conducted to release the obstruction. Operative and pathological findings revealed mucosal damage and necrosis in the small intestine with no ileal stricture and adhesion; approximately 50 cm of the affected region was resected and an ingested 7.5 cm diameter shiitake mushroom was found (figure 2). The small bowel obstruction disappeared upon removal of the mushroom and the patient was discharged on postoperative day 17.Given that mushrooms are rich in fibre, they absorb consumed oils, intestinal fluids and intestinal gases, and show very low attenuation on CT. Moreover, as in the present case, unintentionally swallowing one whole can cause bowel obstruction. Bowel obstruction most likely occurs in the small intestine, given its diameter and weak movements.

We achieved technical success in all four patients with the sole use of short-segment embolization of the long branch of the vasa recta. Our findings suggest that this technique is useful for embolization in cases of colonic hemorrhage.