In summary, the dilemma of positive scintigraphic evidence of colonic bleeding with negative arteriography can be resolved with the use of a metal marker during the scintigram to guide superselective angiography. Though this technique is useful, it is merely designed to be an adjunct to the Selleck Gefitinib currently available modalities of treating colonic bleeding. Although

in our small series of patients this technique appears to be simple, safe and effective, further clinical investigation is warranted with a larger patient population. In life threatening bleeding with positive scintigraphy and negative angiography even Repotrectinib after superselection (as occurred in 3 of our patients) extreme caution should be utilized in embolization AR-13324 molecular weight using the clip localization method. Though in our small series we had no complications this may have been fortuitous. In another series of 5 patients (Burgess et. al.) there was a high rate of colonic ischemia when embolization was performed based on positive scintigraphy alone with negative angiography. The rate of intestinal ischemia was 60% and the mortality from ischemia or uncontrolled bleeding was also 60%. [16] We realize that empiric embolization using this technique may be less precise than standard angiographically positive embolization. This is due to the lack of exact anatomic localization and a definite therapeutic endpoint. However, this technique may

offer a role in therapy in coordination with the colorectal surgeon for the high risk patient in an otherwise life threatening situation. 3-oxoacyl-(acyl-carrier-protein) reductase References 1. Lefkovitz Z, Cappel MS, Kaplan M, Mitty H, Gerard P: Radiology in the Diagnosis and Therapy of Gastrointestinal Bleeding. Gastroenterol Clin North Am 2000, 29:489–512.CrossRefPubMed 2. Billingham RP: The conundrum of lower gastrointestinal bleeding.

Surg Clin N AM 1977, 77:241–52.CrossRef 3. Suzman MS, Talmor M, Jennis R, Binkert B, Barie PS: Accurate localization and surgical management of active lower gastrointestinal hemorrhage with technetium-labeled erythrocyte scintigraphy. Ann Surg 1996,224(1):29–36.CrossRefPubMed 4. Alavi A, Ring EJ: Localization of gastrointestinal bleeding: superiority of 99mTc sulfur colloid compared with angiography. AJR Am J Roentgenol 1981,137(4):741–8.PubMed 5. Zink SI, Ohki SK, Stein B, Zambuto DA, Rosenberg RJ, Choi JJ, Tubbs DS: Noninvasive evaluation of active lower gastrointestinal bleeding: comparison between contrast-enhanced MDCT and 99mTc-labeled RBC scintigraphy. AJR Am J Roentgenol 2008,191(4):1107–14.CrossRefPubMed 6. Rollins ES, Picus D, Hicks ME, Darcy MD, Bower BL, Kleinhoffer MA: Angiography is useful in detecting the source of chronic gastrointestinal bleeding of obscure origin. AJR Am J Roentgenol 1991,156(2):385–8.PubMed 7. Abbas SM, Bissett IP, Holden A, Woodfield JC, Parry BR, Duncan D: Clinical variables associated with positive angiographic localization of lower gastrointestinal bleeding.