Four cases of perforation of the colon above the peritoneal reflection during a barium-enema examination were reviewed with regard to the type of examination, site of perforation, status of the colon, clinical manifestations, mode of detection, and consequences. Perforation above the peritoneal reflection does not seem to be directly related to technical factors. The cecum and ascending colon, with their larger lumina, are the most likely sites. Because such patients are usually asymptomatic at the time, careful examination of post-fluoroscopic radiographs for signs of perforation is strongly recommended.
The use of vasopressin infusion or arterial embolization in the treatment of 87 patients with gastrointestinal hemorrhage is reviewed. A bleeding point was identified angiographically in 46 patients (53%), with a higher success rate in those with upper gastrointestinal hemorrhage (63%) than in those with lower (39%) gastrointestinal hemorrhage. Vasopressin infusion in 33 patients completely stopped hemorrhage in 14 and slowed hemorrhage pending surgery in another 5. Gelfoam embolization was successful as definitive therapy in 12 of 15 patients. Mortality as a result of hemorrhage or its sequelae was 40% in patients with upper gastrointestinal hemorrhage and 21% in those with lower gastrointestinal hemorrhage.
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