Super-Selective Mesenteric Embolization as Guide for Surgical Resection in Bleeding Small Bowel Angiodysplasia

Abstract

We present the case of a 79-year-old woman and of a 43-year-old man with no relevant past medical history. Both patients were admitted to the emergency department for anemia and rectal bleeding. After resuscitation, the two patients underwent colonoscopy and gastroscopy, both negative. Computed tomography angiography revealed active bleeding from the small bowel in both cases. The first patient underwent angiography and mesenteric embolization with surgical glue, obtaining a complete stop of the bleeding. After 2 days, a small bowel resection was performed under the guidance of the segmental bowel ischemia secondary to embolization. In the second patient, the angiography revealed a large jejunal angiodysplasia. Therefore, a mesenteric super-selective embolization was carried out. The intraoperative identification of the coils allowed to guide the following bowel resection. The postoperative course was uneventful in both patients. Small bowel angiodysplasia is a rare cause of lower gastrointestinal bleeding. In most patients, bleeding stops spontaneously. However, patients with ongoing active bleeding non-responding to conservative treatment may need invasive procedures. The use of super-selective mesenteric embolization is highly successful and relatively safe. When surgery is necessary, identification of the bleeding site is troublesome. In this setting, angioembolization could help to identify the correct site of bleeding, thus allowing to perform a segmental small bowel resection.

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Funding

The authors declare that they have no financial ties to disclose.

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All authors contributed to the study. More specifically:

Conceptualization: Paola Germani and Alan Biloslavo

Study design: Paola Germani, Alan Biloslavo, and Stefano Martinolli

Project writing and management: Paola Germani

Defining the study: Paola Germani and Alan Biloslavo

Extensive literature search: Paola Germani

Actually performing the study viz: Paola Germani and Gabriele Bellio

Experiments: n.a.

Practical work: Paola Germani, Gabriele Bellio, Laura Bernardi, and Jacopo Galvanin

Operative work: Paola Germani and Gabriele Bellio

Data acquisition: Gabriele Bellio

Data analysis: n.a.

Statistical inferences: n.a.

Manuscript writing: Paola Germani, Laura Bernardi, and Marina Troian

Repeated editing and reviewing of the manuscript: Paola Germani, Alan Biloslavo, Hayato Kurihara, and Nicolò de Manzini

All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Paola Germani.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in this study.

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Germani, P., Bellio, G., Bernardi, L. et al. Super-Selective Mesenteric Embolization as Guide for Surgical Resection in Bleeding Small Bowel Angiodysplasia. Indian J Surg (2020). https://doi.org/10.1007/s12262-020-02478-3

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Keywords

  • Angiodysplasia
  • Small bowel
  • Angioembolization
  • Micro-coil