Management of angiogram positive lower gastrointestinal hemorrhage: long term follow-up of non-operative treatments

After positive mesenteric angiography for massive lower gastrointestinal hemorrhage, one is faced with a localized bleeding site and the therapeutic options of embolization, vasopressin infusion, observation, or operation. This review was designed to determine long term outcomes of angiographically controlled bleeding. All cases of mesenteric angiography for hemorrhage performed over a twelve year period were reviewed, with focus on those treated non-operatively. A total of 37 patients had angiographically localized bleeding distal to the ligament of Treitz. Twenty-one patients were controlled with vasopressin, embolization, or spontaneous cessation. Only three patients had recurrent bleeding, at one month, one year, and eight years. No patients died from recurrent bleeding. Five patients died without any further bleeding; mean time to death was 2 years. Twelve patients had no further bleeding at a mean follow-up of 2.6 years. Bleeding controlled by any angiographic measure, was followed by recurrent bleeding in 14% without the need for operative intervention.