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Acute lower gastrointestinal bleeding - PubMed

Acute lower gastrointestinal bleeding

Rakesh Navuluri et al. Semin Intervent Radiol. 2012 Sep.

Abstract

The annual incidence of lower gastrointestinal bleeding (LGIB) is ∼20.5 in 100,000 in the general Western population and results in 1 to 2% of hospital emergencies. When medical management and endoscopic therapy are inadequate in cases of acute LGIB, endovascular intervention can be lifesaving. In these emergent situations it is important for the interventional radiologist to be well versed in the multidisciplinary preangiographic work-up, the angiographic presentations of LGIB, and the endovascular therapeutic options. We describe a case of LGIB managed with endovascular embolization and detail the angiographic techniques used, followed by a detailed discussion of the various treatment approaches to LGIB.

Keywords: GI bleeding; embolization; emergent.

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Figures

**Figure 1**
Colonoscopy image of a Dieulafoy lesion within the distal rectum ∼5 cm from the anal verge (arrow).

**Figure 2**
Inferior mesenteric artery arteriogram posteroanterior projection, midarterial phase, demonstrating active extravasation with pooling of contrast (arrow) arising from a prominent right-sided branch of the superior rectal artery.

**Figure 3**
Superior rectal artery angiogram, posteroanterior projection, early arterial phase, with superselection of the prominent right-sided branch using a microcatheter. Gross contrast extravasation from this vessel is confirmed (arrow).

**Figure 4**
Inferior mesenteric artery arteriogram, posteroanterior projection, midarterial phase, with resolution of active extravasation after coil embolization of a right-sided branch of the superior rectal artery.

**Figure 5**
Algorithm for lower gastrointestinal bleeding management and treatment.

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