The lesion is no longer opacified on the superior mesenteric angiogram after embolisation and the bleeding never recurred. 22 year old case of leukaemia, was undergoing chemotherapy and had profuse lower GI bleeding. Microcatheter was advanced into the vasa recta that was spurting blood. A small embolisation coil was deployed into this vessel. Since the advent of vasopressin in the 1960s and embolisation therapy in the 1970s, radiological control of haemorrhage has either obviated emergency surgery altogether or it has replaced the more hazardous emergency colectomy to an elective limited bowel resection, considerably lowering the morbidity and mortality.
Subsequent angiogram shows effective embolisation, with no more bleeding into the small intestine.
Vasopressin acts by constricting the smooth muscle of the blood vessels, as well as the smooth muscle of the bowel wall. Selective intra-arterial infusion of vasopressin into the mesenteric artery had been used widely in lower GI bleed, especially in colonic diverticulosis. Due to the prolonged infusion and its systemic effects, various complications have been encountered. The major problems associated with vasopressin therapy have been hypertension, bradycardia, myocardial infarction, peripheral vascular ischaemia, catheter-related thrombosis and hyponatraemia with water retention. Embolisation to control acute lower GI bleeding was first described by Rosch in the early 1970s to overcome the problem of recurrent bleeding after vasopressin therapy.