Selective embolotherapy as a treatment option for lower gastrointestinal haemorrhage following open-heart surgery

Abstract

Lower gastrointestinal haemorrhage following cardiac surgery is a rare but potentially life threatening complication. Conservative or endoscopic management often fails to detect and control the bleeding, with surgery, often in the form of a major colonic resection, being the last resort. Surgical intervention, however, is associated with high morbidity and mortality. Our case describes the successful management of small bowel haemorrhage, following coronary artery bypass surgery, with angiographic embolotherapy of a branch of the ileocolic artery. We suggest that selective arterial embolisation is a safe and effective therapeutic option available to hospitals undertaking cardiothoracic surgery and should always be considered in the above context.

Mesenteric angiography results in gastrointestinal tract hemorrhages: single center experience

“…Some patients develop mild mucosal ischemia, which in most cases is asymptomatic. Complete clinical success, which is defined as the termination of bleeding following embolotherapy, has been reported to be between 65% and 86%, which was very similar to our series of patients (12)(13)(14). In patients with active bleeding (0.5-1.0 mL/min), mesenteric angiography can localize the site of small bowel bleeding in 50%-72% of patients, but the diagnostic yield drops if active bleeding has slowed or stopped (13).…”

“…Studies in the 1980s showed a 10%-20% incidence of post-embolization infarction, whereas later studies in the 1990s demonstrated few, if any, post-embolization infarction cases (12)(13)(14). The reduction in postembolization infarction has been attributed to the development of finer coaxial systems and microcoils and the increased experience of the interventionalists.…”