Value of angiographic embolisation for the control of major haemorrhage after oesophagogastric or pancreaticobiliary surgery

Objective: To assess the effectiveness of selective mesenteric angiography in finding the bleeding point in patients with haemorrhage after upper gast rointestinal operations, and the efficacy of angiographic haemostasis in co ntrolling haemorrhage. Design: Open study. Setting: University teaching hospital in the United Kingdom. Subjects: 6 patients who required urgent investigation for haemorrhage afte r elective oesophagogastric or pancreaticobiliary operations. Intervention: Mesenteric angiography. Main outcome measures: Identification of bleeding point and control of haem orrhage. Results: Mesenteric angiograms were done at a median of 20 days (range 3-49 ) after operation and identified the site of bleeding in all 6 patients. De finitive control of bleeding was achieved by embolisation in 2. Further att empts at angiographic embolisation failed to control the bleeding in the ot her 4. Conclusion: Mesenteric angiography appears to be a valuable investigation i n patients with postoperative bleeding after upper gastrointestinal operati ons. Angiographic embolisation may help to obtain haemostasis, and may stab ilise a critically ill patient to allow time for more controlled assessment and treatment.