Can Superselective Embolization be Definitive for Colonic Diverticular Hemorrhage? An Institution’s Experience over 9 Years

  • Ker-Kan TanEmail author
  • Vigneswaran Nallathamby
  • Daniel Wong
  • Richard Sim
Original Article



Superselective mesenteric embolization is effective in arresting colonic diverticular hemorrhage with minimal complications, but long-term results are lacking. We aimed to review the short- and long-term outcome of superselective embolization in arresting colonic diverticular hemorrhage in an Asian population.


A retrospective review of all patients who underwent superselective embolization for bleeding colonic diverticula from December 2000 to March 2009 was performed. These cases were drawn from a database of embolization for active gastrointestinal hemorrhage. Short-term outcomes (≤30 days from procedure) identified included rebleeding, ischemia, or any further intervention for any of these two complications. Readmission for rebleeding and/or definitive surgery after 30 days (long-term outcome) was also documented.


Twenty-three patients, median age 65 years (range 41–79 years), formed the study group. Nineteen (82.6%) patients had active hemorrhage from right colonic diverticula while four (17.4%) had left-sided diverticular bleeding. Technical success was achieved in all 23 (100%) patients.

Short-term outcome

Five (21.7%) patients rebled within the same admission, and all underwent surgery. One patient perished from ensuing anastomotic dehiscence and septic shock and accounted for the only mortality (4.3%) in our series. There was no patient with ischemic complications. Another two (8.7%) patients underwent elective surgical resection on the advice of their surgeons in the absence of rebleeding.

Long-term outcome

The median follow-up was 40 months (5–99 months). Of the remaining 16 (69.6%) patients for whom the procedure was definitive initially, four (25.0%) rebled within 2 years from the primary procedure, and elective surgery was performed in one of them. Another had repeat embolization, while the other two were successfully managed conservatively. These three patients refused surgical intervention. One patient was lost to follow-up, and the remaining 11 patients had no further complications.


Superselective embolization for active colonic diverticular hemorrhage is safe and effective and should be considered as a first line treatment if possible and available. The procedure could act as a bridge to a subsequent more definitive elective surgery or be definitive as seen in over 50% of our patients over a period of 40 months.


Embolization Colonic Diverticular Hemorrhage Definitive Treatment 


  1. 1.
    Chen CY, Wu CC, Jao SW, Pai L, Hsiao CW. Colonic diverticular bleeding with comorbid diseases may need elective colectomy. J Gastrointest Surg 2009;13:516–520.CrossRefPubMedGoogle Scholar
  2. 2.
    Gordon RL, Ahl KL, Kerlan RK, Wilson MW, LaBerge JM, Sandhu JS, Ring EJ, Welton ML. Selective arterial embolization for the control of lower gastrointestinal bleeding. Am J Surg 1997;174:24–28.CrossRefPubMedGoogle Scholar
  3. 3.
    Silver A, Bendick P, Wasvary H. Safety and efficacy of superselective angioembolization in control of lower gastrointestinal hemorrhage. Am J Surg 2005;189:361–363.CrossRefPubMedGoogle Scholar
  4. 4.
    Funaki B. Endovascular intervention for the treatment of acute arterial gastrointestinal hemorrhage. Gastroenterol Clin North Am 2002;31:701–713.CrossRefPubMedGoogle Scholar
  5. 5.
    Lee YS. Diverticular disease of the large bowel in Singapore. An autopsy survey. Dis Colon Rectum 1986;29:330–335.CrossRefPubMedGoogle Scholar
  6. 6.
    Wong SK, Ho YH, Leong AP, Seow-Choen F. Clinical behavior of complicated right-sided and left-sided diverticulosis. Dis Colon Rectum 1997;40:344–348.CrossRefPubMedGoogle Scholar
  7. 7.
    Lipof T, Sardella WV, Bartus CM, Johnson KH, Vignati PV, Cohen JL. The efficacy and durability of super-selective embolization in the treatment of lower gastrointestinal bleeding. Dis Colon Rectum 2008;51:301–305.CrossRefPubMedGoogle Scholar
  8. 8.
    DeBarros J, Rosas L, Cohen J, Vignati P, Sardella W, Hallisey M. The changing paradigm for the treatment of colonic hemorrhage: superselective angiographic embolization. Dis Colon Rectum 2002;45:802–808.CrossRefPubMedGoogle Scholar
  9. 9.
    Bookstein JJ, Chlosta EM, Foley D, Walter JF. Transcatheter hemostasis of gastrointestinal bleeding using modified autogenous clot. Radiology 1974;113:277–285.PubMedGoogle Scholar
  10. 10.
    Funaki B, Kostelic JK, Lorenz J, Ha TV, Yip DL, Rosenblum JD, Leef JA, Straus C, Zaleski GX. Superselective microcoil embolization of colonic hemorrhage. AJR Am J Roentgenol 2001;177:829–836.PubMedGoogle Scholar
  11. 11.
    Tan KK, Wong D, Sim R. Superselective embolization for lower gastrointestinal hemorrhage: an institutional review over 7 years. World J Surg 2008;32:2707–2715.CrossRefPubMedGoogle Scholar
  12. 12.
    Luchtefeld MA, Senagore AJ, Szomstein M, Fedeson B, Van Erp J, Rupp S. Evaluation of transarterial embolization for lower gastrointestinal bleeding. Dis Colon Rectum 2000;43:532–534.CrossRefPubMedGoogle Scholar
  13. 13.
    Ahmed TM, Cowley JB, Robinson G, Hartley JE, Nicholson AA, Lim M, Ettles DF, Monson JR. Long term follow up of transcatheter coil embolotherapy for major colonic hemorrhage. Colorectal Dis 2009, in press.Google Scholar
  14. 14.
    Koh DC, Luchtefeld MA, Kim DG, Knox MF, Fedeson BC, Vanerp JS, Mustert BR. Efficacy of transarterial embolization as definitive treatment in lower gastrointestinal bleeding. Colorectal Dis 2009;11:53–59.CrossRefPubMedGoogle Scholar
  15. 15.
    Anthony S, Milburn S, Uberoi R. Multi-detector CT: review of its use in acute GI hemorrhage. Clin Radiol 2007;62:938–949.CrossRefPubMedGoogle Scholar
  16. 16.
    Laing CJ, Tobias T, Rosenblum DI, Banker WL, Tseng L, Tamarkin SW. Acute gastrointestinal bleeding: emerging role of multidetector CT angiography and review of current imaging techniques. Radiographics 2007;27:1055–1070.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Ker-Kan Tan
    • 1
    Email author
  • Vigneswaran Nallathamby
    • 1
  • Daniel Wong
    • 2
  • Richard Sim
    • 1
  1. 1.Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
  2. 2.Department of Diagnostic RadiologyTan Tock Seng HospitalSingaporeSingapore

Personalised recommendations