Mesenteric angiography for the localization and treatment of acute lower gastrointestinal bleeding

• Published in: Canadian Journal of Surgery Vol. 51; no. 6; pp. 437 - 441
• Main Authors: Karanicolas, Paul J., MD, Colquhoun, Patrick H., MD, MSc, Dahlke, Erin, BSc, Guyatt, Gordon H., MD, MSc
• Format: Journal Article
• Language: French; English
• Published: Canada CMA Impact Inc 01.12.2008; CMA Impact, Inc; Canadian Medical Association
• Subjects: Aged; Aged, 80 and over; Angiography; Care and treatment; Diagnosis; Female; Gastrointestinal bleeding; Gastrointestinal diseases; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; Health aspects; Humans; Intestines - blood supply; Male; Medical diagnosis; Medical imaging; Mesentery - blood supply; Mesentery - diagnostic imaging; Middle Aged; Original; Patient outcomes; Practice; Risk factors; Studies; Surgeons; Surgery; Treatment Outcome; Canada; London Ontario Canada
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1016/S0008-428X(08)50120-2

Background There is limited evidence regarding the effectiveness and complications of mesenteric angiography in the diagnosis and management of acute lower gastrointestinal bleeding (ALGIB). Our objective was to determine the complications and outcomes of mesenteric angiography in patients with ALGIB and to identify predictors of a positive result at angiography. Methods We identified and reviewed the records of all patients who underwent mesenteric angiography for ALGIB at our institution during a 10-year period. We compared potential predictors of positive versus negative angiograms. Results Of 47 mesenteric angiograms in 35 patients, 22 (47%, 95% confidence interval [CI] 33%–61%) revealed a source of bleeding, most commonly the colon. Hematomas developed in the groins of 3 patients (6.4%, 95% CI 0%–18%), and 1 of these patients also experienced a myocardial infarction during the procedure. None of the potential predictors were significantly associated with a positive result at angiography, although the confidence intervals were wide. Twenty patients (57%, 95% CI 41%–74%) continued to bleed after the angiogram, and 18 of the patients (51%, 95% CI 35%–68%) were discharged without a definitive diagnosis. Conclusion With a diagnostic success of about 50%, mesenteric angiography may play an important part in the diagnosis and management of patients with ALGIB; however, one or more large, prospective multicentre studies are needed to more clearly define its role. Canadian surgeons have the opportunity to initiate collaborative multicentre studies to address such diagnostic and therapeutic clinical questions.