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Transarterial embolization in acute colonic bleeding: review of 11years of experience and long-term results

Rossetti, Andrea ; Buchs, Nicolas ; Breguet, Romain ; Bucher, Pascal ; Terraz, Sylvain ; Morel, Philippe

In: International Journal of Colorectal Disease, 2013, vol. 28, no. 6, p. 777-782

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    Titre
    • Transarterial embolization in acute colonic bleeding: review of 11years of experience and long-term results
    Auteur
    • Rossetti, Andrea. Clinic for Visceral Surgery and Transplantation, Department of Surgery, University Hospital of Geneva, 1211, Geneva, Rue Gabrielle-Perret-Gentil 4, Switzerland
    • Buchs, Nicolas. Clinic for Visceral Surgery and Transplantation, Department of Surgery, University Hospital of Geneva, 1211, Geneva, Rue Gabrielle-Perret-Gentil 4, Switzerland
    • Breguet, Romain. Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
    • Bucher, Pascal. Clinic for Visceral Surgery and Transplantation, Department of Surgery, University Hospital of Geneva, 1211, Geneva, Rue Gabrielle-Perret-Gentil 4, Switzerland
    • Terraz, Sylvain. Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
    • Morel, Philippe. Clinic for Visceral Surgery and Transplantation, Department of Surgery, University Hospital of Geneva, 1211, Geneva, Rue Gabrielle-Perret-Gentil 4, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • International Journal of Colorectal Disease, 2013, vol. 28, no. 6, p. 777-782. Springer-Verlag
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:318791
    Summary
    Background: Lower gastrointestinal bleeding represents 20% of all gastrointestinal bleedings. Interventional radiology has transformed the treatment of this pathology, but the long-term outcome after selective embolization has been poorly evaluated. The aim of this study is thus to evaluate the short-term and long-term outcomes after selective embolization for colonic bleeding. Methods: From November 1998 to December 2010, all acute colonic embolizations for hemorrhage were retrospectively reviewed and analyzed. The risk factors for post-embolization ischemia were also assessed. Results: Twenty-four patients underwent colonic embolization. There were 6 men and 18 women with a median age of 80years (range, 42-94years). The underlying etiologies included diverticular disease (41.9%), post-polypectomy bleeding (16.7%), malignancy (8.2%), hemorrhoid (4.1%), and angiodysplasia (4.1%). In 23 patients, bleeding stopped (95.8%) after selective embolization. One patient presented a recurrence of bleeding with hemorrhagic shock and required urgent hemorrhoidal ligature. Four patients required an emergent surgical procedure because of an ischemic event (16.7%). One patient died of ileal ischemia (mortality, 4.1%). The level of embolization and the length of hypoperfused colon after embolization were the only risk factors for emergent operation. Mean hospital stay was 18days (range, 9-44days). After a mean follow-up of 28.6months (range, 4-108months), no other ischemic events occurred. Conclusion: In our series, selective transarterial embolization for acute colonic bleeding was clinically effective with a 21% risk of bowel ischemia. The level of embolization and the length of the hypoperfused colon after embolization should be taken into consideration for emergent operation