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Pharmacologically Controlled Visceral Bleeding by Means of an Intra-Arterial Catheter

1969; Radiological Society of North America; Volume: 93; Issue: 6 Linguagem: Inglês

10.1148/93.6.1379

1527-1315

Peter Slezák, R. Lewander, Bengt Fredricsson,

Muscle and Compartmental Disorders

By infusion of a vasoactive substance through an intra-arterial catheter it is possible to check profuse internal bleeding that might otherwise be difficult to control. This method has been used successfully in a few cases of hemorrhage from the upper alimentary tract (1). After the source of bleeding is localized, a catheter is placed selectively into the artery feeding the region (a radiolucent polyethylene catheter type PE-205 is preferred), and a solution of vaso-pressin in physiologic saline is infused. For the catheterization of the arteries, the same method is used as for any other selective arteriography. This paper describes the use of this technic in the management of a patient with severe bleeding of the rectum and lower urogenital tract. Case Report A 68-year-old female with a malignant ovarian tumor was admitted to the hospital because of massive hematuria and bleeding from the rectum. The hemorrhage was continuous, and the patient became comatose and pu1seless. Within twenty-four hours, she had lost between 3,000 and 4,000 ml blood, and the hemoglobin values varied between 8.9 and 9.4 g per 100 ml. Repeated blood transfusions, Macrodex, and plasma kept the patient in an acceptable condition. Pelvic arteriography was carried out in order to localize, if possible, the source of bleeding. The pelvic arteriogram showed bleeding from a branch of the internal iliac artery (Fig. 1). With the help of television-screening, a catheter of Mikaelsson type (3) was introduced into the left internal iliac artery in an attempt to stop the bleeding by an intra-arterial vasopressin infusion and thereby make an operation unnecessary. Twelve international units of Postacton were diluted in 1,000 ml physiologic saline and infused with a motor-powered infusion-aggregate at a speed of 0.75 ml per minute. The previously low blood pressure became stabilized at a normal level. The bladder catheter was changed and the bladder washed out. At the beginning, the urine contained many blood clots but soon became clear, indicating that the hemorrhage had stopped. Six international units of Postacton were then infused over twelve hours and the dose repeated over the same time period after intervals of six hours. No bleeding was observed during this period. During the second day after the arteriography the patient's central venous pressure rose, and evidence of cardiac failure appeared. The urinary output diminished. The electrocardiogram showed signs of a general myocardial affection, and the chest roentgenogram revealed basal densities, pleural effusions, and cardiac enlargement. The patient was given digitalis and diuretics, and her general condition soon improved. On the third day, arteriography was repeated. No leakage of contrast material into the bladder was apparent (Fig. 2). The treatment was continued for three days and a total dose of 25 international units of Postacton was administered.