Massive hemorrhage in the lower gastrointestinal tract in adults: diagnostic imaging and intervention.

Zuckerman, Darryl A.; Bocchini, T P; Birnbaum, Elisa H.

doi:10.2214/ajr.161.4.8372742

Cited by 106 publications

(31 citation statements)

References 43 publications

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“…Various bail-out procedures have been proposed to manage acute arterial dissection, including prolonged dilatation with an angioplasty balloon [1], atherectomy to excise the dissection flap [2], and permanent stent placement [3,4]. Permanent stenting is the most successful approach for sealing off the dissection.…”

Section: Discussionmentioning

confidence: 99%

“…Permanent stenting is the most successful approach for sealing off the dissection. However, permanent stenting of the popliteal artery is complicated by subacute thrombosis in up to 30% of cases and a 50% 4-year restenosis rate [3,4]. For lower superficial femoral artery and popliteal lesions permanent stent placement is not generally advocated.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of rectal hemorrhage by coil embolization

Dobson

Nicholson

1999

Cardiovasc Intervent Radiol

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Four patients, aged 54-84 years, presenting with life-threatening rectal bleeding from the superior hemorrhoidal artery, underwent percutaneous fibered platinum coil embolization via coaxial catheters. Pre-procedure sigmoidoscopy had failed to identify the source of hemorrhage, because the rectum was filled with fresh blood. Embolization was technically and clinically successful in all four patients. Subsequent sigmoidoscopy confirmed the diagnoses in three patients as a solitary rectal ulcer, iatrogenic traumatic ulceration following manual evacuation, and a rectal Dieulafoy's lesion. The other case was angiographically seen to be due to a rectal angiodysplasia. Embolization is an effective procedure in life-threatening superior hemorrhoidal arterial bleeding when endoscopic treatment fails, and should be preferred to rectosigmoid resection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment of rectal hemorrhage by coil embolization

Dobson

Nicholson

1999

Cardiovasc Intervent Radiol

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“…Various studies have shown that in cases of upper gastrointestinal bleeding transarterial embolization as compared to surgical hemostasis has proven to be equally effective while being less invasive; associated with a lower post-interventional mortality, and, thus, being accepted as the method of preference. Moreover, TAE has shown to be effective even after unsuccessful surgery or a previous unsuccessful TAE [17][18][19][20]. Overall, the rate of surgical procedures in upper GI bleeding has decreased to less than 2% nowadays [21].…”

Section: Discussionmentioning

confidence: 99%

“…A further method of arterial hemostasis constitutes a vasopressin infusion, technically easier to perform since it requires less equipment and time [20,[30][31][32]. However, one of the disadvantages of this method lies in the fact that the catheter must remain inside the patient's vessel for one to two days, which increases the risk of complications such as thromboses or infections at the catheter site in the common femoral artery [33].…”

Section: Discussionmentioning

confidence: 99%

Transcatheter arterial embolisation in upper gastrointestinal bleeding in a sample of 29 patients in a gastrointestinal referral center in Germany

et al. 2015

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Objective: This is a retrospective analysis of interventional embolisation performed with catheter angiography in 29 patients with upper gastrointestinal bleeding in the setting of a secondary care hospital. Patients, Materials, and Methods: From April 2007 to February 2013, 29 patients with upper gastrointestinal bleeding underwent endovascular diagnostics and treatment. The diagnosis was established by endoscopy, computed tomography or clinically based on a significant decrease in hemoglobin. Transcatheter arterial embolisation was performed with coils, liquid embolic agents, and particles. The technical and clinical outcomes were assessed by postinterventional endoscopy, hemoglobin concentrations, number of necessary transfusions, or surgical interventions, as well as by post-interventional mortality within 28 days after the procedure. Results: Selective angiographic embolisation in upper gastrointestinal bleeding was primarily successful technically and clinically in 22 of 29 patients. In 4/29 cases an angiographic reintervention was performed, which was successful in 3?cases. In 3 cases of primarily technically unsuccessful procedures reintervention was not attempted. No catheterisation-related complications were recorded. Peri-interventional mortality was 31?%, but only 2 of these patients died due to uncontrolled massive bleeding, whereas the lethal outcome in the other 7 patients was due to their underlying diseases. Conclusion: Transcatheter arterial embolisation is an effective and rapid method in the management of upper gastrointestinal bleeding. Radiological endovascular interventions may considerably contribute to reduced mortality in GI bleeding by avoiding a potential surgical procedure following unsuccessful endoscopic treatment. The study underlines the importance of the combination of interventional endoscopy with interventional radiology in secondary care hospitals for patient outcome in complex and complicated upper gastrointestinal bleeding situations.

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“…It requires a blood debit of more than 1 ml/min (15). In order to detect the point of bleeding angiography must be carried out at the moment of the hemorrhage, and this is often intermittent.…”

Section: Discussionmentioning

confidence: 99%

Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

Couto-Worner

González-Conde

Estévez-Prieto

et al. 2013

Rev. esp. enferm. dig.

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Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20 % of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting, with correct visualization of the point of bleeding. Patients recovered well avoiding other aggressive procedures such as angiography or surgery.

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Massive hemorrhage in the lower gastrointestinal tract in adults: diagnostic imaging and intervention.

Cited by 106 publications

References 43 publications

Treatment of rectal hemorrhage by coil embolization

Treatment of rectal hemorrhage by coil embolization

Transcatheter arterial embolisation in upper gastrointestinal bleeding in a sample of 29 patients in a gastrointestinal referral center in Germany

Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

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