Arterial Embolization in the Management of Mesenteric Bleeding Secondary to Blunt Abdominal Trauma

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Ghelfi, Julien | Frandon, Julien | Barbois, Sandrine | Vendrell, Anne | Rodiere, Mathieu | Sengel, Christian | Bricault, Ivan | Arvieux, Catherine | Ferretti, Gilbert, R. | Thony, Frédéric

Edité par CCSD ; Cardiovascular and Interventional Radiological Society of Europe (CIRSE). -

International audience. INTRODUCTION:Mesenteric bleeding is a rare but potentially life-threatening complication of blunt abdominal trauma. It can induce active hemorrhage and a compressive hematoma leading to bowel ischemia. Emergency laparotomy remains the gold standard treatment. We aimed to study the effectiveness and complications of embolization in patients with post-traumatic mesenteric bleeding.MATERIALS AND METHODS:The medical records of 7 consecutive patients with active mesenteric bleeding treated by embolization in a level-one trauma center from 2007 to 2014 were retrospectively reviewed. All patients presented with active mesenteric bleeding on CT scans without major signs of intestinal ischemia. We focused on technical success, clinical success, and the complications of embolization.RESULTS:Six endovascular procedures were successful in controlling hemorrhage but 1 patient had surgery to stop associated arterial and venous bleeding. One patient suffered from bowel ischemia, a major complication of embolization, which was confirmed by surgery. No acute renal failure was noted after angiography. For 1 patient we performed combined management as the endovascular approach allowed an easier surgical exploration.CONCLUSION:In mesenteric trauma with active bleeding, embolization is a valuable alternative to surgery and should be considered, taking into account the risk of bowel ischemia.

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