What are the possible complications of superselective embolization for the treatment of lower gastrointestinal (GI) bleeding (LGIB)?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Answer

Rosenkrantz et al reported three cases of colonic infarction following embolization. [70] One patient died following segmental colectomy, and the other patients revealed full-thickness bowel wall injury in the resected specimen. Intestinal ischemia and infarction have also been reported. To prevent this complication, perform embolization beyond the marginal artery as close as possible to the bleeding point in the terminal mural arteries. At least 139 cases have been collected from the medical literature since 1972.

The relevance of surgery after embolization of GI bleeding has also been examined. In a retrospective study, a total of 54 patients with 55 bleeding events were identified; only 25 patients (45%) had lower GI bleeding (LGIB). [71] Of those, 9 patients had bleeding in the small intestine, 14 in the colon, and 2 in the rectum. The rebleeding rate was 24% (n=6), and 50% of those with recurrent LGIB required surgery. [71]

This study revealed a primary clinical embolization success rate of 82%, an 18% rate of early recurrent bleeding (< 30 days), and a 3.6% rate of delayed bleeding (>30 days). [71] Surgery after embolization was required in 20% of patients (n=11). The investigators concluded that surgery has an important role after successful embolization. [71]


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