Acute gastrointestinal haemorrhage

Melanoma metastasis to small bowel

The CT scan (Fig. 6.32) demonstrates dense contrast in a loop of bowel despite the lack of oral contrast having been given. This is extravasation of IV contrast - active bleeding from a loop of small bowel, there is no mass seen to suggest a tumour and no signs of inflammatory change in the adjacent mesentery.

A superior mesenteric artery arteriogram (Fig. 6.33) was performed and 298 this shows active bleeding from the mid-pelvic region consistent with bleeding coming from the distal jejunum or ileum. A microcatheter was passed further distally (Fig. 6.34) and active bleeding is again seen - contrast passes into the small bowel lumen. The final image of the series (Fig. 6.35) shows embolisation coils, but no evidence of continued active bleeding. The distal position of the coils reduces the chance of small bowel ischaemia. The bleeding lesion was later identified as a melanoma metastasis. Complications from angiography are rare, bleeding from the puncture site is the most common occuring in approximately 3%. (see Table 6.7).

Table 6.7 Complication from angiography

• Contrast reaction

• Deterioration in renal function secondary to contrast load

■ Puncture site

• Pseudoaneurysm formation (Fig. 6.36)

• Thrombosis/vessel occlusion

• Embolism of clot or plaque; air embolus

• Dissection of vessel wall

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