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Digestive and Liver Disease 43 (2011) e22
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Digestive and Liver Disease
jou rn al h om epage: www.elsev ier .com/ locate /d ld
mage of the month
ostembolization small bowel ischaemia
austo Rosa ∗, Sergio Alfieri, Antonio Pio Tortorelli, Giovanni Battista Dogliettoepartment of Digestive Surgery, Catholic University, “A. Gemelli” Hospital, Rome, Italy
r t i c l e i n f o
rticle history:eceived 17 March 2011ccepted 22 April 2011
vailable online 8 June 2011A 28-year-old man presented with massive gastrointestinalaemorrhage and hypovolemic shock. His haemoglobin levelropped to 5 g/dl over a six-hour period. Emergency upperndoscopy to the second part of the duodenum showed nobnormalities. Digital subtraction visceral angiography was per-ormed. Superior mesenteric arteriography revealed bleeding from
marginal branch of the ileocolic artery (Fig. 1A, arrow) that sup-lied the distal ileum, consistent with small bowel angiodysplasia.uperselective mesenteric embolization with gelatin sponges waserformed (Fig. 1B, arrow).
Twelve hours after this procedure, the patient complainedf crampy abdominal pain in the lower quadrants. On physi-al examination, the abdomen was tender and diffusely tense.aboratory findings revealed increased levels of lactate dehydro-enase (1065 IU/L), hematocrit (75%) and neutrophil granulocytes17.220 mm−3).
Under the suspicion of intestinal ischaemia, an exploratoryaparotomy was performed, and a 5 cm ischaemic ileal loop wasound and resected (Fig. 2).
The patient recovered uneventfully and was discharged on post-perative day 4.
Small bowel ischaemia represents a rare side effect afteruperselective mesenteric embolization in patients with acute gas-rointestinal bleeding, 3% according to the most recent series [1].
∗ Corresponding author. Tel.: +39 3393910715; fax: +39 06 30156579.E-mail address: [email protected] (F. Rosa).
[
590-8658/$36.00 © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevieroi:10.1016/j.dld.2011.04.019
Moreover, subsequent surgery may be associated with a higher riskof anastomotic leak [1].
Reference
1] Tan KK, Wong D, Sim R. Superselective embolization for lower gastroin-testinal hemorrhage: an institutional review over 7 years. World J Surg2008;32:2707–15.
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