Brief Article
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World J Gastroenterol. Oct 28, 2013; 19(40): 6869-6875
Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6869
Transarterial embolization for massive gastrointestinal hemorrhage following abdominal surgery
Chun-Gao Zhou, Hai-Bin Shi, Sheng Liu, Zheng-Qiang Yang, Lin-Bo Zhao, Jin-Guo Xia, Wei-Zhong Zhou, Lin-Sun Li
Chun-Gao Zhou, Hai-Bin Shi, Sheng Liu, Zheng-Qiang Yang, Lin-Bo Zhao, Jin-Guo Xia, Wei-Zhong Zhou, Lin-Sun Li, Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Author contributions: Zhou CG and Shi HB designed the study and wrote the manuscript; Liu S and Yang ZQ performed the transarterial embolization procedures; Zhou CG, Zhao LB, Xia JG and Zhou WZ assisted in patient recruitment and interviews; Shi HB and Li LS corrected the manuscript.
Correspondence to: Dr. Hai-Bin Shi, Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China. hbshi346@163.com
Telephone: +86-25-83724440 Fax: +86-25-83724440
Received: June 12, 2013
Revised: July 29, 2013
Accepted: August 16, 2013
Published online: October 28, 2013
Processing time: 154 Days and 1.2 Hours
Abstract

AIM: To evaluate the clinical results of angiography and embolization for massive gastrointestinal hemorrhage after abdominal surgery.

METHODS: This retrospective study included 26 patients with postoperative hemorrhage after abdominal surgery. All patients underwent emergency transarterial angiography, and 21 patients underwent emergency embolization. We retrospectively analyzed the angiographic features and the clinical outcomes of transcatheter arterial embolization.

RESULTS: Angiography showed that a discrete bleeding focus was detected in 21 (81%) of 26 patients. Positive angiographic findings included extravasations of contrast medium (n = 9), pseudoaneurysms (n = 9), and fusiform aneurysms (n = 3). Transarterial embolization was technically successful in 21 (95%) of 22 patients. Clinical success was achieved in 18 (82%) of 22 patients. No postembolization complications were observed. Three patients died of rebleeding.

CONCLUSION: The positive rate of angiographic findings in 26 patients with postoperative gastrointestinal hemorrhage was 81%. Transcatheter arterial embolization seems to be an effective and safe method in the management of postoperative gastrointestinal hemorrhage.

Keywords: Transcatheter arterial embolization; Postoperative hemorrhage; Complications; Surgery

Core tip: Postoperative gastrointestinal hemorrhage is a potentially fatal complication after abdominal surgery. It is difficult for surgeons to deal with it. Reoperation is often difficult or even unsuccessful in patients with postoperative hemorrhage, especially those with two or more previous abdominal operations, due to the anatomical inaccessibility of the arteries, postoperative adhesions, and inflammatory reactions. This study showed that transcatheter embolization was a useful microinvasive treatment option for the identification and occlusion of a massive bleeding site after abdominal surgery.