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Case Reports
. 2007 Feb;21(2):117-23.
doi: 10.1155/2007/272641.

Catheter-directed middle hemorrhoidal artery embolization for life-threatening rectal bleeding

Mubin I Syed  1 , Najeeb Chaudhry, Azim Shaikh, Kamal Morar, Kumar Mukerjee, Earl Damallie
Affiliations
Case Reports

Catheter-directed middle hemorrhoidal artery embolization for life-threatening rectal bleeding

Mubin I Syed et al. Can J Gastroenterol. 2007 Feb.

Abstract
in English, French

Over the past 10 years, arteriography has become a well-established technique for the diagnosis of acute lower gastrointestinal bleeding, but not particularly for rectal bleeding. However, to the authors' knowledge, the technique of middle hemorrhoidal artery embolization has rarely been reported in the literature. In the present report, three patients with life-threatening rectal bleeding are presented, which was controlled by superselective embolization of the middle hemorrhoidal artery or selective embolization of the internal iliac artery as a last resort.

Depuis une dizaine d’années, l’artériographie est devenue une technique reconnue pour le diagnostic de l’hémorragie digestive basse, mais moins reconnue dans les cas d’hémorragie rectale. Par contre, à la connaissance des auteurs, la technique d’embolisation de l’artère hémorrhoïdale médiane n’avait encore jamais été mentionnée dans la littérature. Le présent rapport fait état de trois cas présentant une hémorragie rectale gravissime qui a pu être maîtrisée par l’embolisation supersélective de l’artère hémorrhoïdale médiane ou l’embolisation sélective de l’artère iliaque interne, en dernier ressort.

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Figures

Figure 1)
Figure 1)
Case 1 – Preembolization arteriogram of the right internal iliac artery showing the extravasation site (arrowhead)
Figure 2)
Figure 2)
Case 1 – Delayed preembolization arteriogram of the same right internal iliac artery showing the extravasation site (arrowhead), which is now much easier to see
Figure 3)
Figure 3)
Case 1 – Preembolization arteriogram of the same right internal iliac artery showing the extravasation site (arrrowhead) and the middle hemmorhoidal artery (arrow) through a different projection
Figure 4)
Figure 4)
Case 1 – Postembolization arteriogram of the selected right middle hemmorhoidal artery. The extravasation site is no longer seen
Figure 5)
Figure 5)
Case 2 – Nuclear medicine-tagged red blood cell scan showing the bleeding site from rectum (arrow)
Figure 6)
Figure 6)
Case 2 – Preembolization arteriogram of the right internal iliac artery showing the extravasation site (arrowhead) and the middle hemorrhoidal artery (arrow)
Figure 7)
Figure 7)
Case 2 – A selective middle hemorrhoidal arteriogram showing extravasation (arrow) from the site of the distal artery
Figure 8)
Figure 8)
Case 2 – Postembolizaton arteriogram of the right internal iliac artery showing the right middle hemorrhoidal artery (arrow). Note the lack of the extravasation site
Figure 9)
Figure 9)
Proposed algorithm for the treatment of rectal bleeding. GI Gastrointestinal; RBC Red blood cell
See this image and copyright information in PMC

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