Colonic embolisation: useful but caution required

See article on page79 The value of diagnostic visceral angiography in the investigation and management of acute and chronic gastrointestinal bleeding is well established, its use in this role having been first described over 35 years ago.1 It is possible to identify the source of haemorrhage in 87% of patients actively bleeding at the time of the study, and to identify a lesion which could be responsible for the problem in 74% of those not bleeding at the time of investigation.2 These figures are dependent on a number of factors, including the use of meticulous angiographic technique, the quality of the imaging equipment and the experience of the operator in both the acquisition and interpretation of data.3 In a patient thought to be actively bleeding at the time of the angiogram, the vessel most likely to be responsible is examined first—for example, the inferior mesenteric artery (IMA) in rectal bleeding, the coeliac axis in haematemesis. If a source is not found then the other major visceral vessels are studied in turn. If the superior mesenteric artery (SMA) and IMA studies appear normal in a case of bleeding thought clinically to be of lower gastrointestinal origin, the coeliac axis should also be studied, not only because …