Can a lower GI bleed be treated with empiric embolization?
The colon and small bowel lack the extensive collateral network present in the stomach and duodenum. Empiric embolization of a vascular distribution would cause extensive ischemia and bowel necrosis. The approach to lower GI bleeds is therefore much different. To perform an embolization, the site of bleeding must be identified on the angiogram. Nuclear medicine scans to detect bleeding are often performed before an arteriogram. These scans are noninvasive and can detect intermittent bleeding and hemorrhage that is much slower than that which can be detected on an arteriogram. If the nuclear medicine scan shows negative results, it is of virtually no value to perform an arteriogram. If the nuclear medicine scan shows positive results, and the site of hemorrhage can be identified on the arteriogram, embolization can be attempted.