Treatment of rectal hemorrhage by coil embolization

Abstract

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.

Massive Hematochezia from Acute Hemorrhagic Rectal Ulcer in Patients with Severe Comorbid Illness: Rapid Control of Bleeding by Per Anal Suturing of Bleeder Using Anoretractor

“…Treatment of severe hematochezia from rectal ulcer with angiographic embolization has been reported. 19 However, angiography may not prove applicable because of delay in bleeding management; and higher rate of rebleeding.…”

Emborrhoid: A New Concept for the Treatment of Hemorrhoids with Arterial Embolization: The First 14 Cases

“…These patients were not suitable for other medical or surgical treatments and suffered from severe rectal bleeding. The multidisciplinary team took into account the fact that in emergency situations rectal embolization with coils has been shown to be safe and effective [7][8][9][10][11][12]. The multidisciplinary team did not ask IRB approval for coil embolisation of the superior rectal artery as it was considered as ''compassionate'' treatment.…”

“…Emborrhoid consists of arterial occlusion of the superior rectal arteries (SRA) with coils. In the literature, few case reports have demonstrated the efficacy of embolization of the superior rectal arteries for life-threatening rectal bleeding of various origins [7][8][9][10][11][12].…”

Benign rectal ulcer

“…Endoscopic coagulation or local application of epinephrine appears to have been successful in five of eight reported applications; this method was used successfully in our series in one patient. Embolization was effective in controlling bleeding from benign rectal ulceration in one of the two cases reported in this series and in three patients treated by Dobson and Nicholson [10]. Local excision or banding also appeared to be highly effective; successful control of a rectal source was achieved in nine of 11 cases, including our failure following embolization.…”