Abstract
A 65-year-old man visited our hospital for melena. Enhanced CT at the emergency department could not reveal the bleeding site. He was admitted to our hospital on the same day. Over-night, he bled several times. The next day, enhanced CT revealed extravasation of contrast medium around the hepatic flexure of the colon. We decided on an interventional radiological approach. The bleeding site of unknown cause was detected.
The bleeding was supplied by the right branch of the middle colic artery and right colic artery. Arterial embolization with coil was successful for the former. However, this was not the case for the latter. We injected N-butyl-2-cyanoacrylate (Histoacryl) and fatty acid ethyl esters of iodized poppy seed oil(Lipiodol) into the right colic artery using an immaturely advanced catheter. Hemostasis was achieved. On the third day after arterial embolization, his body temperature increased to over 39.5°C. Enhanced CT revealed loss of blood supply of the colon at the splenic flexure. We diagnosed this part of the colon as necrotic. Emergency laparoscopic right hemicolectomy saved his life. In conclusion, comprehensive knowledge of embolic materials is critical. Moreover, although the laparoscopic approach is challenging in this situation, it can be feasible when skilful surgeons are involved.
