Small-Bowel Bleeding With Laparoscopic Resection Guided by Microcoil Placement

Introduction: Small-bowel massive bleeding presents a complex diagnostic and therapeutic problem. Angiography can be used for localization and embolization of the overt gastrointestinal bleeding site. Because of the complex anastomotic network of blood vessels supplying the small intestine, precise identification is complicated and surgical resection of the bleeding site is difficult. We describe angiography-directed preoperative microcoil placement for a localization of the bleeding site using intraoperative fluoroscopy during laparoscopic small-bowel resection. Case Description: The described method was used successfully in a 58-year-old woman who was started on a chemotherapy regimen of idarubicin and cytarabine, which has been reported to cause small-bowel hemorrhage, occasionally resulting in fatal outcomes. Overt small intestinal bleeding developed due to enteritis that was unresponsive to conservative therapy and required massive blood transfusions. Discussion: Many modalities are available for diagnosing and treating obscure small intestinal bleeding when only few of them are suitable for overt bleeding management. We offer an innovative approach that may successfully service the void of an effective technique to treat massive small intestinal bleeding resistant to conservative treatment.