A Case of Traumatic Mesenteric Bleeding in which Emergent Surgery Could be Avoided by Transcatheter Arterial Embolization

Abstract

A 44-year-old man got a hard blow on the left side of the abdomen when he had fallen down three meters. On arrival at the hospital, he was in a state of shock, but he responded to bolus doses of intravenous infusion. A contrast-enhanced computed tomography (CT) scan revealed a large retroperitoneal hematoma behind the descending colon with active extravasation of the contrast medium. We made a diagnosis of active bleeding from the inferior mesenteric artery (IMA). Then we decided to perform transcatheter arterial embolization (TAE) to control the bleeding, though colon ischemia might occur. Selective angiography of the IMA showed active bleeding from a marginal artery of the IMA branches. Soon after the TAE, hemodynamics became stable even without sustained catecholamine injection. A CT scan on the next day showed an edematous descending colon, which was confirmed as segmental mucous membrane necrosis of the descending colon by the colonoscopy. Then resection of the partial descending colon was performed with an uneventful postoperative course. He came home at 8 p.o. day.