Postembolic colonic infarction.

Abstract

From a total of 23 cases from five hospitals, acute colonic mucosal necrosis developed in three patients following transcatheter embolotherapy for colonic hemorrhage. Although embolic therapy for lower gastrointestinal bleeding is associated with appreciable risk, these risks are less than those of emergency operation for hemorrhage. The alternative transcatheter therapeutic modality, vasopressin infusion, is often associated with continued or recurrent hemorrhage, is relatively contraindicated in patients with coronary disease, and produces numerous complications. Transcatheter embolotherapy is recommended for patients with colonic bleeding who have a contraindication to vasopressin administration, who are refractory to vasopressin, or who rebleed following treatment with vasopressin.

Long-term results of microcoil embolization for colonic haemorrhage: how common is rebleeding?

“…6 Given the lack of a dual blood supply in the lower GI tract, it was perceived that embolization could never effectively treat lower tract bleeding without compromising healthy enteric tissue. [7][8][9][10] However, innovations in coaxial technique have allowed for a superselective approach to bleeding vessels, resulting in continued high rates of haemostasis with reduced instances of ischaemia. Numerous studies in recent years have demonstrated this benefit, [11][12][13][14][15][16][17] contributing to the overall acceptance of embolization as a legitimate and even preferred treatment option in the management of acute massive colonic haemorrhage.…”

Colocutaneous fistula complicating therapeutic mesenteric embolisation

“…3 In early series, the incidence of colonic infarction was reported to be as high as 20%. The use of superselective embolisation to deliver particulate size of 100 µm or larger 4 into the most distal arterial branches has resulted in a reduction of this complication with only 10% requiring surgery for ischaemia.…”

Transcatheter embolization of the marginal artery of drummond as treatment for life-threatening retroperitoneal hemorrhage complicating heparin therapy

“…Vasopressin infusion has been the treatment of choice in patients with mesenteric bleeding, often as a prelude to resection of the affected hemicolon. We have used vasopressin infrequently because hemorrhage is frequently not controlled or hemorrhage commonly recurs after discontinuation of vasopressin ( [8], KJ Cho, unpublished data). Furthermore, the vasoconstrictive effects of vasopressin may result in small bowel infarction and peripheral or myocardial ischemia [9,10].…”

“…The reported complications of mesenteric embolotherapy are mesenteric ischemia and colonic stricture [8,12,16,17]. The exact incidence of mesenteric ischemia following embolization is unknown because the complication will depend on the level, extent, and site of mesenteric arterial occlusion by embolization and the state of local collateral circulation.…”