1Jehanzeb Shahid,1Tanveer ul Haq, 1Tanveer ul Haq, 1Junaid Iqbal

1Aga Khan University Hospital

Background(s):

GI bleed is one of the most commonly encountered emergencies of interventional radiology. Role of distal micro coil embolisation as compared to sole particle embolisation for lower GI bleeds is well established in literature as well as is recommended by various IR societies. Sole particle embolisation is less favoured due to risk of bowel ischemia. Catheter angiography and embolisation is usually preceded by diagnostic imaging (usually a CT bleeding protocol or RBC tag scan). One problem which IR some times encounter is diagnostic imaging test being positive for GI bleed but catheter angiography shows negative mesenteric DSA. This may occur partially due to the fact that arterial GI bleeds may some times by transient and may have already partially responded to medical treatment. But at the same time, just diagnostic DSA without intervention carries significant risk of re-bleed. The objective of our study is therefore to access the clinical outcomes of empiric particle embolisation at ileocecal area in patients with positive CT bleeding protocol and negative mesenteric angiography.

Material(s) and Method(s):

We retrospectively evaluated all of the patients from January 2016 to February 2022 who had positive bleeding protocol CT with focus of bleeding at ileocecal area. A total of 42 patients were identified. Out of those 42 patients, 26 patients had mesenteric angiogram positive for active bleeding and were therefore embolised using coil embolisation or a combination of coils and particles. 16 patients (n=16) were those with negative mesenteric angiogram for active bleeding and were our final sample size. Empiric embolisation of ileocecal area was performed in those patients using medium to large sized PVA particles (355-500 or 500-710 microns). The clinical outcome was identified on the basis of post embolisation rebleeding, clinical signs of bowel ischemia post embolisation and mean hospital stay post embolisation.

Result(s):

Out of 16 patients, re-bleeding was encountered in 3 patients with a mean time of re-bleed of 18 hours. One of the patient died of recurrent bleed and also developed multi organ failure later.  Non of the patients developed clinical signs of bowel ischemia or bowel infarct which was also assesed by LDH levels. Mean hospital stay post embolisation was 3.2 days. Embolisation procedural technical success rate was 100%.

Conclusion(s):

Our study concluded that empiric particle embolisation carries a lower actual risk of bowel ischemia in patients with positive CT bleeding protocol but negative mesenteric angiogram. Furthermore, it also reduces the risk of re-bleeds and impacts the mean hospital stay duration.