In Reply to: Case 0298_07 --Bleeding from the descending colon posted by Editor on February 03, 1998 at 11:59:05:
Very nice case illustrating important points, not the least of which is persistence. In terms of mamagenet of bleeding, I have been struck by how late we are often asked to get involved with GI bleeding these days, often with disastrous results from repeated endoscopic attempts at stopping the bleeding (such as cauterizing right throught the wall of the duodenum trying for the fourth time in as many days to stop a bleeding ulcer we could easily have nailed).
When asked to get involved, we scan for lower bleeds always; if the scan is positive we angio emergently, if not we do it urgently but not emergently.
Your case brings up the question of whether we should routinely vasodilate before doing the run (eg with Priscoline), or should we always go back post vasodilation if the first run is negative. Other tricks such as CO2 have been described when the initial run is negative.
A question: did you scope the patient in follow-up to look for ischema? Incidentally I agree wholeheartedly with coils as opposed to particles which others have advocated in this setting.