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 Fig. 1. SMA angiography demonstrates the prominent site of extravasation. The jejunostromy catheter and a caval filter are also seen. |
 Fig. 2. Close-up of the bleeding site. |
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A 29-year-old man with HIV disease and multiple medical problems presented with brisk bright red blood exiting through his jejunostomy catheter. Emergent angiography demonstrates a brisk bleeding site. Vasopressin infusion failed to control the bleeding and the patient underwent emergent exploratory laparotomy. A foot long segment of inflamed and ulcerated small bowel was removed and cytomegalovirus (CMV) colitis was diagnosed. Questions: 1) We did not attempt, or offer embolization for this bleeding for fear that it was too 'central,' spanned too broad an area and would be a high risk for infarction. Where is a safe level for embolotherapy? At the vasa recta, at the bowel surface, more proximally (with potential collateralization, etc? Are microcatheter delivered coils still the best agent? Related cases: Case 0598_10 -- Rectosigmoid hemorrhage with reflux to small bowel Case 0298_07 --Bleeding from the descending colon Case 597_09 -- Heparin challenge angiography for diagnosis of occult GI bleeding Case 397_08 -- Colic artery hemorrhage MM#96-21--Gangrenous Complications Of Intraarterial Vasopressin For Treatment Of Lower GI Bleeding |
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