Transcatheter arterial embolization for initial hemostasis in a hemodynamically unstable patient with mesenteric hemorrhage: A case report

Abstract

Surgical treatment of mesenteric injuries is necessary to control hemorrhage, manage bowel injuries, and evaluate bowel perfusion. It has recently been suggested that some patients can be managed with transcatheter arterial embolization (TAE) for initial hemostasis. We present a hemodynamically unstable patient who was initially managed by TAE for traumatic mesenteric hemorrhage. A 60-year-old man was injured in a motor vehicle accident and transported to our facility. On arrival, the patient was hemodynamically stable, and had abdominal pain. Physical examination revealed a seatbelt sign on the lower abdomen. A contrast-enhanced computed tomography (CT) scan showed intra-abdominal hemorrhage, mesenteric hematoma, and a giant-pseudoaneurysm, but no intra-abdominal free air or changes in the appearance of the bowel wall. After the CT scan, his vital signs deteriorated and surgical intervention was considered, but TAE was performed to control the hemorrhage. After TAE, the patient was hemodynamically stable and had no abdominal tenderness. A follow-up CT scan was performed 2 days later which showed partial necrosis of the transverse colon and some free air. Resection of the injured transverse colon with primary anastomosis was performed. The patient improved and was discharged 35 days after injury. TAE can be effective as the initial hemostatic procedure in patients with traumatic mesenteric hemorrhage.

Blunt abdominal trauma managed with mesenteric embolization: case report

“…However, it has been seen that embolization can also be performed in these patients if open surgery is delayed, since it allows initial bleeding control and surgical intervention is facilitated. Using a combined approach reduces hemorrhagic shock due to blood loss before reaching the operating room 13 . Otherwise, those who do respond or are hemodynamically stable from the start should be treated according to their injury.…”

Traumatismo abdominal contuso manejado con embolización mesentérica: reporte de caso

“…Sin embargo, se ha visto que en estos pacientes también se puede hacer una embolización si la cirugía abierta se retrasa, ya que permite realizar un control inicial del sangrado y se facilita la intervención quirúrgica. Haciendo un abordaje combinado disminuye el shock hemorrágico por pérdida de sangre antes de llegar al quirófano 13 . De otra manera, los que sí responden o desde el principio están hemodinámicamente estables deben ser tratados según su lesión.…”

“…El seguimiento debe ser con exploraciones físicas seriadas y control imagenológico. Si se detectara alguna anormalidad, habría que considerar la exploración quirúrgica 13 .…”

“…Dentro de las complicaciones posteriores al procedimiento inicial, se presentó isquemia intestinal en un paciente. Por otro lado, en un reporte de caso presentado en 2019 por Nakama, et al 13 , en el cual se evaluó el tratamiento de embolización mesentérica en un paciente posterior a un accidente automovilístico, este presentó deterioro clínico durante la exploración física seriada y requirió una nueva evaluación imagenológica, que confirmó necrosis intestinal y por ello el paciente fue llevado a laparotomía. Por esto se da importancia a la exploración física seriado tras la embolización, como se hizo en nuestro caso.…”

A case of spontaneous mesenteric hematoma successfully diagnosed and treated with aggressive imaging

“…CT is required to rule out other more common causes of abdominal pain and shock, including abdominal aneurysm, malignancy, and acute pancreatitis. If the patient is hemodynamically stable and contrast-enhanced CT suggests a diagnosis of mesenteric hematoma for the bleeding origin, selective visceral angiography should be performed and the bleeding vessels should be embolized if identified [9].…”