Emergency arterial embolization of upper gastrointestinal and jejunal tumors: An analysis of 12 patients with severe bleeding.

PURPOSE: The goal of this study was to retrospectively assess the efficacy of emergency percutaneous transcatheter arterial embolization in patients with severe bleeding due to upper gastrointestinal or jejunal tumor. MATERIALS AND METHODS: Twelve patients (7 men, 5 women; mean age, 74 years±14 (SD); range: 54-86 years) with severe bleeding from the upper gastrointestinal tract, with failed endoscopic treatment not eligible for emergency surgery were treated by emergency percutaneous transcatheter arterial embolization. The bleeding cause was gastric tumor in 7 patients, duodenal tumor in 4 patients and jejunal tumor in one patient. Procedure details and follow-up were reviewed. RESULTS: Twelve embolization procedures were performed using various embolic agents. Embolization was achieved and bleeding was stopped in all patients. Five patients underwent surgery within the 30 days following embolization. In the remaining 7 patients, no bleeding occurred at 1 month follow-up in 6 patients and bleeding recurred in one patient at 1 month. In this later patient, endoscopic treatment was successful. CONCLUSION: The results of our study suggest that transcatheter arterial embolization is safe and effective in patients with severe arterial bleeding due to upper gastrointestinal or jejunal tumor. In some patients, transcatheter arterial embolization can be used as a bridge to surgery.

Assessment of patients with acute mesenteric ischemia: multislice computed tomography signs and clinical performance in a group of patients with surgical correlation.

AIM: The aim of this paper was to describe signs and performance of multislice computed tomography (MSCT) in patients with acute mesenteric infarction (AMI). METHODS: MSCT examinations of 26 patients with AMI and of 34 patients with acute abdomen and surgical diagnosis excluding AMI were retrospectively analyzed. All studies were performed with arterial and portal venous phase scans, 2.5 mm thickness, 1.25 mm image interval. All abnormal findings at MSCT in patients with AMI were recor- ded. Patients with MSCT evidence of mesenteric artery occlusion or pneumatosis or venous gas or, alternatively, bowel thicken-ing associated with lack of wall enhancement or venous thrombosis or parenchimal infarction were considered to be affected by AMI. RESULTS: AMI was due to mesenteric artery thrombosis in 17 patients, mesenteric vein thrombosis in 7, and nonocclusive ischemia in 2. In 16/17 patients arterial thrombosis was visualized, in 7/7 venous thrombosis was found. Portal or mesenteric vein gas was seen in 5% and pneumatosis in 38%; bowel wall thickening associated with other signs was found in 31%. Sensitivity and specificity were 92% and 100%, respectively. CONCLUSIONS: MSCT allows an accurate assessment of the mesenteric circulation and the bowel wall. This makes possible optimal visualization of signs of AMI resulting in a good clinical performance.