pituitrin and Arteriovenous-Malformations

Interventional radiology is defined as a radiologic subspecialty and the services provided are tabulated in this article; those services relevant to internists are described in greater detail. This article is intended as a survey, and the authors encourage the reader to consult the references provided for a more in-depth review.

Topics: Abscess; Angiography; Angioplasty, Balloon; Arterial Occlusive Diseases; Arteriovenous Malformations; Biopsy, Needle; Cholestasis; Drainage; Embolization, Therapeutic; Fibrinolytic Agents; Gastrointestinal Hemorrhage; Hemoptysis; Humans; Neoplasms; Peptic Ulcer; Radiography; Vasopressins

Topics: Angiography; Arteriovenous Malformations; Catheterization; Embolization, Therapeutic; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Neoplasms; Regional Blood Flow; Vasopressins; Wounds and Injuries

Fifty patients with massive lower gastrointestinal bleeding were initially managed with emergency angiography. The average age was 67.2; mean hematocrit, 23.7; and average transfusion, 7.6 units. Thirty-six patients (72%) had bleeding site located; bleeding sites were distributed throughout the colon. Etiologies of bleeding included diverticular disease (19 patients) and arteriovenous malformations (15 patients). Twenty of 22 (91%) patients receiving selective intra-arterial vasopressin stopped bleeding; however, 50% rebled on cessation of vasopressin. Thirty-five of 50 (70%) patients underwent surgery, with 57% operated on electively after vasopressin therapy. Seventeen patients had segmental colectomy, with no rebleeding. Nine of the 17 patients had diverticular disease in the remaining colon. Operative morbidity in these 35 patients was significantly improved when compared to previously reported patients undergoing emergency subtotal colectomy without angiography (8.6% vs. 37%) (p less than 0.02). Emergency angiography successfully locates the bleeding site, allowing for segmental colectomy. Vasopressin infusion transiently halts bleeding, permitting elective surgery in many instances.

Topics: Adult; Aged; Angiography; Arteriovenous Malformations; Barium Sulfate; Colectomy; Colon; Diverticulum; Diverticulum, Colon; Emergencies; Female; Gastrointestinal Hemorrhage; Humans; Male; Mesenteric Arteries; Middle Aged; Vasopressins

Lower intestinal bleeding related to enterocolic angiodysplasia is now accepted as a common clinical situation in the elderly. A planned approach is mandatory to allow early localization and appropriate therapy. Colonoscopy, scintigraphy and angiography used judiciously have almost entirely replaced exploratory laparotomy as a diagnostic tool. Nonoperative treatment comprising arteriographic selective vasopressin infusion and endoscopic coagulation has been followed in some cases by hemorrhage control. Such techniques, if easily obtainable, have their place; however, surgery remains the ultimate method for definitive treatment. A previous knowledge of the nature of ileal involvement is essential if surgical hemostasis is to be achieved. The recent successful management of three patients exemplifies the problems found in dealing with iliocecal bleeding angiodysplasia.

Topics: Aged; Arteriovenous Malformations; Blood Transfusion; Cecum; Colonoscopy; Female; Gastrointestinal Hemorrhage; Humans; Ileum; Male; Middle Aged; Vasopressins

Topics: Adult; Aged; Arteriovenous Malformations; Colonic Diseases; Diverticulum, Colon; Female; Gastrointestinal Hemorrhage; Humans; Intestine, Small; Intestines; Male; Middle Aged; Rectal Diseases; Vasopressins