pituitrin and Colonic-Diseases

Topics: Colectomy; Colonic Diseases; Colonoscopy; Gastrointestinal Hemorrhage; Humans; Rectum; Vasopressins

Topics: Aged; Body Water; Central Venous Pressure; Colon; Colonic Diseases; Diet, Sodium-Restricted; Female; Hematocrit; Humans; Male; Middle Aged; Osmolar Concentration; Plasma Volume; Potassium; Rectal Diseases; Rectum; Salts; Sodium; Sodium Chloride; Surgical Procedures, Operative; Time Factors; Urine; Vasopressins; Water

Technological advances in the last couple of decades have led to a tremendous improvement in the safety and efficacy of embolization making it the therapeutic intervention of choice in angiogram positive lower gastrointestinal bleeding. Vasopressin has thus been forgotten and it is hardly ever used by the current generation of interventionists. However, coil embolization is technically challenging and requires greater expertise. Difficulty in super-selective catheterization and lack of adequate collateralization can also prevent successful delivery of coils. In this article we present the successful use of intra-arterial vasopressin in a patient with Crohn's disease with severe lower gastrointestinal bleeding. Despite not being the first choice, vasopressin can be safely and effectively used in selected patients who are not candidates for embolotherapy. The purpose of this article is to discuss the relative merits and demerits of vasopressin vis-à-vis embolization and to identify the role of vasopressin in the current era of super-selective embolization. Successful control of massive lower gastrointestinal bleeding by intra-arterial vasopressin infusion has previously been reported only once before in Crohn's disease. We suggest that this technique may be used in an attempt to avoid surgery in these patients.

Topics: Catheterization, Peripheral; Colonic Diseases; Crohn Disease; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Male; Mesenteric Arteries; Mesenteric Artery, Superior; Middle Aged; Vasopressins

Multiorgan system failure due to hypotension and sepsis is an important cause of death in patients with bowel obstruction. We have investigated the pathophysiology of this entity in an animal model. After 5 days of bowel obstruction, blood flow in the superior mesenteric artery was measured with and without Pitressin and norepinephrine given in separate experiments. In controls, Pitressin in moderate dosages caused a substantial fall in gut blood flow, which was not seen in obstructed animals (blood flow reduction 52 percent vs. 11 percent in sham and obstructed animals respectively, P less than 0.01). Similarly, norepinephrine infusion had less of an effect on gut blood flow in obstructed animals (blood flow reduction 79 percent vs. 58 percent sham vs. obstructed animals (P less than 0.05). Thus, both agents had dose-related effects on gut blood flow, which was maintained at a higher level throughout the drug infusion periods in the bowel of obstructed animals, demonstrating that splanchnic flow is less responsive to vasoactive drug infusion under these experimental conditions. Because splanchnic vasoconstriction is an important feature of normal hemodynamic homeostasis, we suggest that these results may help explain some aspects of the pathophysiology of multiorgan failure caused or worsened by systemic hypotension seen in bowel obstruction.

Topics: Animals; Blood Pressure; Cardiac Output; Colonic Diseases; Female; Intestinal Obstruction; Male; Norepinephrine; Splanchnic Circulation; Swine; Vasopressins

Intraarterial vasopressin infusion of the inferior mesenteric artery was used in the treatment of 2 patients with massive hemorrhage following colonoscopic polypectomy. Both patients had multiple medical problems and were considered to be very-high-risk candidates for emergency surgery. Arteriography readily demonstrated the site of bleeding, and vasopressin infusion effectively controlled the hemorrhage in both patients without complication. Angiographic management allowed elective colonic resection 1 month later in 1 patient and prevented surgery in the other who has not bled again in the 6 months following the procedure. The role of arteriography in the management of postpolypectomy hemorrhage is discussed.

Topics: Aged; Catheterization; Colonic Diseases; Colonic Polyps; Female; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Male; Mesenteric Arteries; Postoperative Complications; Radiography; Vasopressins

Topics: Colonic Diseases; Combined Modality Therapy; Embolization, Therapeutic; Gastrointestinal Hemorrhage; Humans; Rectum; Vasopressins

A 5-year-old girl with biliary atresia is described who developed lower gastrointestinal bleeding from colonic varices. Vasopressin infusions temporarily controlled the bleeding. Following a right hemicolectomy the bleeding has not recurred.

Topics: Child, Preschool; Colon; Colonic Diseases; Female; Gastrointestinal Hemorrhage; Humans; Radiography; Vasopressins

Topics: Adolescent; Adult; Age Factors; Aged; Child; Colectomy; Colitis, Ulcerative; Colonic Diseases; Colonoscopy; Electrocoagulation; Embolization, Therapeutic; Gastrointestinal Hemorrhage; Humans; Injections, Intra-Arterial; Injections, Intravenous; Intestine, Small; Laser Therapy; Mesenteric Arteries; Middle Aged; Radiography; Vasopressins

The synthetic drug Ornipressin was injected through a 3-French catheter introduced into the superior or inferior mesenteric artery by a coaxial method in nine patients with massive bleeding from the colon. In all patients the bleeding was stopped. In one female patient with a tumour, bleeding recurred, but was stopped by embolisation treatment. There were no complications needing treatment. As a method of treatment for bleeding from diverticula, the following procedure is recommended: an attempt should be made to stop bleeding by injecting vasopressin, or one of its derivatives and the use of a 3-French catheter by a co-axial method is advantageous. If vasopressin is contra-indicated, or is unsuccessful, catheter embolisation is recommended.

Topics: Aged; Catheterization; Colonic Diseases; Embolization, Therapeutic; Female; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Male; Mesenteric Arteries; Middle Aged; Ornipressin; Radiography; Vasopressins

Topics: Angiography; Catheters, Indwelling; Colonic Diseases; Endoscopy; Esophageal Diseases; Gastrointestinal Hemorrhage; Hemobilia; Humans; Hypertension, Portal; Intestinal Diseases; Peptic Ulcer Hemorrhage; Stomach Diseases; Vasoconstrictor Agents; Vasopressins

Topics: Adult; Colon; Colonic Diseases; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Male; Mesenteric Arteries; Radiography; Vasopressins

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

A case of a massive colonic hemorrhage in nontoxic, quiescent ulcerative colitis is described. The source of active colonic bleeding was primarily defined with selective superior mesenteric arteriography and was completely controlled with transcatheter vasopressin infusion. A suubsequent elective segmental distal transverse and descending colectomy revealed chronic ulcerative colitis; localized marked inflammatory giant pseudopolyp formation near the splenic flexure was responsible for the bleeding.

Topics: Aged; Chronic Disease; Colitis, Ulcerative; Colonic Diseases; Female; Gastrointestinal Hemorrhage; Humans; Radiography; Vasopressins

Topics: Adult; Aged; Angiography; Colonic Diseases; Diverticulum, Colon; Gastrointestinal Hemorrhage; Humans; Male; Mesenteric Arteries; Mesenteric Veins; Middle Aged; Perfusion; Vasopressins

Topics: Anemia; Angiography; Celiac Artery; Colonic Diseases; Contrast Media; Gastrointestinal Hemorrhage; Humans; Intestinal Neoplasms; Melena; Mesenteric Arteries; Time Factors; Vasopressins

Topics: Adult; Aged; Arteries; Capillaries; Celiac Artery; Colonic Diseases; Diverticulum, Colon; Duodenal Ulcer; Epinephrine; Gastritis; Gastrointestinal Hemorrhage; Hernia, Diaphragmatic; Humans; Infusions, Parenteral; Male; Mallory-Weiss Syndrome; Mesenteric Arteries; Middle Aged; Peptic Ulcer Hemorrhage; Radiography; Stomach Ulcer; Vasopressins

Topics: Adolescent; Adult; Age Factors; Angiography; Bradykinin; Cecal Diseases; Colectomy; Colitis, Ulcerative; Colon; Colon, Sigmoid; Colonic Diseases; Crohn Disease; Duodenal Diseases; Female; Humans; Intestines; Jejunum; Male; Mesenteric Arteries; Middle Aged; Phlebography; Rectal Diseases; Sex Factors; Vasodilator Agents; Vasopressins

Topics: Adolescent; Anemia; Appendectomy; Appendicitis; Blood Chemical Analysis; Child; Colonic Diseases; Hernia, Inguinal; Humans; Hypersplenism; Infant; Intestinal Obstruction; Intussusception; Jaundice; Jaundice, Obstructive; Megacolon; Osteomyelitis; Sinusitis; Surgical Procedures, Operative; Thrombosis; Vasopressins; Wilms Tumor