Abstract
A 39-year-old female on chronic hemodiaiysis therapy since 1981 presented with tarry stool in 1985. Gastrofiberscopy and barium enema revealed no abnormal findings. In 1989 the patient presented with abdominal pain and tarry stool. Although gastrofiberscopy revealed no active bleeding in the stomach or duodenum, the massive gastrointestinal bleeding continued. Selective visceral angiography was performed, which disclosed active intestinal bleeding from the first branch of the superior mesenteric artery. Embolization with a stainless steel coil was performed to control the hemorrhage. Although embolization appeared to be effective, the patient underwent laparotomy because of the possibility of bowel necrosis or infarction. A small ulcer associated with an open-ended artery was noted in the jejunum about 1cm distal to Treitz's ligament, and local resection of the bleeding area was performed.
If endoscopy, upper gastrointestinal x-ray or barium enema are negative in a hemodialysis patient with massive gastrointestinal bleeding, selective intestinal arteriography and subsequent selective embolization are useful in diagnosing and controling the bleeding.
