Massive lower gastrointestinal hemorrhage from the surgical anastomosis inpatients with multiorgan trauma: Treatment by subselective embolization with polyvinyl alcohol particles

Purpose: To evaluate the efficacy and safety of subselective arterial embol ization with polyvinyl alcohol (PVA) particles with or without microcoil au gmentation to control postoperative lower gastrointestinal (GI) bleeding. Methods: Ten patients with clinical, scintigraphic, and angiographic eviden ce of postoperative lower GI bleeding were considered for subselective embo lization. Subselective embolizations were performed through coaxial microca theters with 355-500 mu m PVA particles with or without additional coil emb olization. Results: Embolization was technically successful in 9 of 10 (90%) patients. In one patient, subselective embolization was not possible; consequently n o embolization was performed. Clinical success was achieved after a single embolization in 6 of 10 (60%) patients and after a second embolization in a n additional 3 of the 10 (30%) patients. While there was no rebleeding in p atients with normal coagulation parameters, all three patients (100%) with coagulopathy rebled, two of them from another source. Although no acute isc hemic effects developed, no long-term sequela such as ischemic stricture we re specifically looked for. Seven patients developed abdominal discomfort a nd/or fever within 24-48 hr. Four of 10 patients died of complications othe r than hemorrhage or ischemia, Conclusion: Subselective PVA embolization with or without a microcoil embol ization is an effective and safe means of managing postoperative lower GI h emorrhage in patients with multiorgan trauma.