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. 1998 Jul;43(1):79–84. doi: 10.1136/gut.43.1.79

Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage

A Nicholson 1, D Ettles 1, J Hartley 1, I Curzon 1, P Lee 1, G Duthie 1, J Monson 1
PMCID: PMC1727187  PMID: 9771409

Abstract

Background—The management of major colonic bleeding is problematic. A proportion of patients require emergency surgery which is associated with high morbidity and mortality. Percutaneous embolotherapy, previously considered a high risk procedure in the colon, may provide an alternative treatment in this group of patients. 
Aims—To assess the safety and efficacy of embolotherapy in the treatment of life threatening colonic haemorrhage. 
Patients and methods—Thirty eight patients with fresh haemorrhage per rectum were referred for surgery because of failed conservative treatment. All underwent angiography; in 14 a bleeding site or vascular abnormality was detected. A coaxial catheter was directed to the most distal bleeding artery and this was embolised with platinum coils. 
Results—Detection of a bleeding site correlated with haemodynamic stability at the time of angiography (r=1 for a systolic blood pressure less than 100 mm Hg). Bleeding sites or vascular abnormalities were detected and embolised in 14 patients (37%). In 12/14 there was immediate and sustained haemodynamic improvement; two continued to bleed and required emergency hemicolectomy (14%). Three developed ischaemic complications (21.4%); these were managed conservatively and required no intervention. The 30 day mortality was 7.1% in the embolotherapy group and 10.5% in the overall group of 38patients. 
Conclusion—Colonic embolotherapy for life threatening haemorrhage is an effective, relatively safe procedure with a low incidence of major complications. Its use depends on the identification of a focal bleeding point or vascular abnormality, which in turn depends on the haemodynamic stability of the patient at the time of angiography. 



Keywords: colonic haemorrhage; embolisation; angiography; angiodysplasia; diverticular disease

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Figure 1 .

Figure 1

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Digital subtraction angiography of the superior mesenteric artery, with superselective cannulation of a caecal branch of the ileocolic artery, showing haemorrhage into the caecal pole. 


Figure 2 .

Figure 2

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Introduction of a distal coil resulting in almost instantaneous arrest of haemorrhage. 


Figure 3 .

Figure 3

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Results of angiography in patients with major colonic haemorrhage, April 1995 to April 1997. SMA, superior mesenteric artery; IMA, inferior mesenteric artery. 


Figure 4 .

Figure 4

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Angiography indicated bleeding sites at the hepatic flexure and caecal pole. The hepatic flexure coil was placed too close to the marginal artery. Though haemorrhage ceased immediately, an occult ischaemic stricture developed at the site (see fig 5). The caecal pole coils produced immediate haemostasis with no complications. 


Figure 5 .

Figure 5

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Ischaemic stricture at the hepatic flexure following coil embolisation in the middle colic artery territory (see fig 4). 


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