Transcatheter Embolization in Patients with Massive Upper Gastrointestinal Hemorrhage

ABSTRACT

Angiography and transcatheter embolization were performed in 12 patients with massive UGI bleeding from March 1990 to Feburuary 1996. These patients were all men of a mean age of 46 years (range, 33~76 years). Causes of bleeding were duodenal ulcer(5 cases), pseudoaneurysm(3 cases) due to chronic pancreatitis, hemobilia(2 cases) due to trauma, gastric mucosal injury(1 case) due to drug ingestion. Celiac arteriography and superior mesenteric arteriography were performed. Embolization was done in 12 patients. Embolic agents were steel coils. Eleven patients show an extravasaton of contrast media on angiography. In one patient who shows no extravasation, an pseudoaneurysm in gastroduodenal artery was found. Sources of bleeding were gastroduodenal artery(8), right hepatic artery(2), left hepatic artery(1), and left gastric artery(1). Bleeding was successfully controlled in all 12 patients. Two patients, however, rebled and an operation was performed. In one patient with pseudoaneurysm, bleeding recurred 13 days after embolization. This patient underwent second embolotherapy and operation 14 days later. There were no complication related to the procedure. Angiographic localization and transcatheter embolization can be an safe and effective treatment for massive UGI hemorrhage, especially in patients considered poor candidate for operation.