A Case of Laparoscopic Colectomy for Intestinal Necrosis After TAE to Lower Gastrointestinal Bleeding

Takuya Yamaguchi, MD. Mimihara General Hospital.

 A 65-year-old man visited our hospital for melena. Enhanced computed tomography(CT )could not reveal the bleeding site at emergency room. He admitted our hospital on the day. Over night,he bleeds several times. On the next day, Enhanced CT revealed extravasation of contrast medium at around hepatic flexure of the colon. We choose interventional radiologic approach. The bleeding site of unknown cause was detected.

The bleeding was supplied from the right branch of the middle colic artery and right colic artery. Arterial embolization with coil was successfully for the former artery. However, it was’t fit for the later artery. Finally, we inject N-butyl-2-cyanoacrylate (Histoacryl) and fatty acid ethyl esters of iodized poppy seed oil(Lipiodol) into the right colic artery with immaturely advanced catheter. Hemostasis was achieved. On the third day after the arterial embolization, body temperature increased over 39.5 degree Celsius. Enhanced CT revealed loss of blood supply of the colon at the splenic flexure. We diagnosed this part of the colon is necrotic. Emergency surgery of laparoscopic right hemicolectomy saved his life. In conclusion, a comprehensive knowledge of embolic materials is critical. And laparoscopic approach is challenging in this situation, however it can be feasible with skillful surgeons.

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