TRANSCATHETER COIL EMBOLOTHERAPY - A SAFE AND EFFECTIVE OPTION FOR MAJOR COLONIC HEMORRHAGE

Background-The management of major colonic bleeding is problematic. A proportion of patients require emergency surgery which is associated w ith high morbidity and mortality. Percutaneous embolotherapy, previous ly considered a high risk procedure in the colon, may provide an alter native treatment in this group of patients. Aims-To assess the safety and efficacy of embolotherapy in the treatment of life threatening col onic haemorrhage. Patients and methods-Thirty eight patients with fres h haemorrhage per rectum were referred for surgery because of failed c onservative treatment. All underwent angiography; in 14 a bleeding sit e or vascular abnormality was detected. A coaxial catheter was directe d to the most distal bleeding artery and this was embolised with plati num coils. Results-Detection of a bleeding site correlated with haemod ynamic stability at the time of angiography (r=1 for a systolic blood pressure less than 100 mm Hg). Bleeding sites or vascular abnormalitie s were detected and embolised in 14 patients (37%). In 12/14 there was immediate and sustained haemodynamic improvement; two continued to bl eed and required emergency hemicolectomy (14%). Three developed ischae mic complications (21.4%); these were managed conservatively and requi red no intervention. The 30 day mortality was 7.1% in the embolotherap y group and 10.5% in the overall group of 38 patients. Conclusion-Colo nic embolotherapy for life threatening haemorrhage is an effective, re latively safe procedure with a low incidence of major complications. I ts use depends on the identification of a focal bleeding point or vasc ular abnormality, which in turn depends on the haemodynamic stability of the patient at the time of angiography.