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Superselective Microcoil Embolization of Colonic Hemorrhage

Brian Funaki1, Jonathan K. Kostelic2, Jonathan Lorenz1, Thuong Van Ha1, Doris L. Yip1, Jordan D. Rosenblum1, Jeffrey A. Leef1, Christopher Straus1 and George X. Zaleski3

1 Department of Radiology, The University of Chicago Hospitals, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60637.
2 Central Kentucky Radiology, 2365 Harrodsburg Rd., Ste. B125, Lexington, KY 40504.
3 Racine Radiologist Group, 3803 Spring St., Rm. 208, Racine, WI 53405.



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  		Fig. 1A. —Microcoil embolization of diverticular sigmoid hemorrhage in 80-year-old woman. 99mTc-RBC scan shows increased activity in sigmoid colon.

 


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  		Fig. 1B. —Microcoil embolization of diverticular sigmoid hemorrhage in 80-year-old woman. Digital subtraction inferior mesenteric arteriogram shows active bleeding in sigmoid colon (arrow).

 


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  		Fig. 1C. —Microcoil embolization of diverticular sigmoid hemorrhage in 80-year-old woman. Fluoroscopic image shows two microcoils deployed at site of bleeding.

 


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  		Fig. 1D. —Microcoil embolization of diverticular sigmoid hemorrhage in 80-year-old woman. Repeated digital subtraction arteriogram through microcatheter reveals no further bleeding.

 


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  		Fig. 2A. —Embolization of right colonic hemorrhage in 49-year-old man. Digital subtraction superior mesenteric angiogram shows extravasation in right colon near cecum (arrow).

 


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  		Fig. 2B. —Embolization of right colonic hemorrhage in 49-year-old man. Superselective angiogram obtained through microcatheter after embolization shows microcoil occlusion of bleeding artery (arrow).

 


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  		Fig. 2C. —Embolization of right colonic hemorrhage in 49-year-old man. Digital subtraction superior mesenteric angiogram after embolization shows no further bleeding.

 


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  		Fig. 3. —Diagram shows results of 27 patients who underwent attempted embolization for colonic hemorrhage. IMA = inferior mesenteric artery.

 


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  		Fig. 4A. —Microcoil embolization in 84-year-old woman with rectal barium impaction performed after failed colonoscopy. Digital subtraction inferior mesenteric arteriogram shows bleeding from left side of rectum (arrow). Note retained barium in sigmoid and rectum (arrowhead).

 


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  		Fig. 4B. —Microcoil embolization in 84-year-old woman with rectal barium impaction performed after failed colonoscopy. Superselective arteriogram through microcatheter shows active hemorrhage from left rectum (arrow).

 


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  		Fig. 4C. —Microcoil embolization in 84-year-old woman with rectal barium impaction performed after failed colonoscopy. Repeated superselective arteriogram after embolization shows no further hemorrhage. Note right orthotopic ureterocele. Patient's condition stabilized after embolization, but less severe bleeding recurred 12 hr later and patient underwent successful endoscopic treatment.

 


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  		Fig. 5A. —Bowel infarction after embolization in 68-year-old woman. Digital subtraction inferior mesenteric arteriogram shows hemorrhage in splenic flexure of colon (arrow).

 


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  		Fig. 5B. —Bowel infarction after embolization in 68-year-old woman. Repeated digital subtraction inferior mesenteric arteriogram after embolization shows no extravasation. Microcatheter could not be advanced to source of bleeding; therefore, microcoils were deployed in marginal artery approximately 5 cm below bleeding site.

 


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  		Fig. 5C. —Bowel infarction after embolization in 68-year-old woman. Digital subtraction superior mesenteric arteriogram obtained after initial marginal artery embolization shows continued bleeding at splenic flexure (arrow).

 


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  		Fig. 5D. —Bowel infarction after embolization in 68-year-old woman. Digital subtraction superior mesenteric arteriogram obtained after additional marginal artery embolization shows no further extravasation. Approximately 1 week after embolization, left hemicolectomy was performed for continued pain and pathologic analysis revealed bowel infarction.

 

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