Superselective microcoil embolization of colonic hemorrhage

OBJECTIVE. We evaluated therapeutic microcoil embolization in a group of pa tients with severe colonic hemorrhage. MATERIALS AND METHODS. Twenty-seven patients with severe colonic bleeding d ue to diverticular disease (n = 19), angiodysplasia (n = 6), cecal ulcer (n = 1), or unknown cause (n = 1) underwent attempted microcoil embolization (n = 25). Microcatheters were used in all procedures, and embolization was performed at the level of the vasa recta or the marginal artery of Drummond . Branches of the superior mesenteric artery were embolized in 12 patients, branches of the inferior mesenteric artery were embolized in 12 patients, and branches of both the superior and inferior mesenteric arteries were emb olized in one patient. RESULTS. Technical success was achieved in 93% (25/27) of the procedures. H owever, immediate hemostasis occurred in 96% (26/27) of patients because in one failed procedure, an occlusive dissection of the inferior mesenteric a rtery arrested bleeding. Three patients rebled within 24 hr. One patient wa s treated with endoscopic cauterization, and two patients underwent right h emicolectomy. One patient who underwent right hemicolectomy for rebleeding had ischemic changes found on pathologic analysis of the resected specimen, and a second patient who underwent embolization of branches of the superio r and inferior mesenteric arteries developed bowel infarction requiring lef t hemicolectomy. Prolonged clinical success occurred in 81% (22/27) of pati ents. CONCLUSION. Therapeutic microcoil embolization for severe colonic hemorrhag e is an effective and well-tolerated procedure.