The branches of the SMA and inferior mesenteric artery (IMA) were suspected by DSA presentation, and during the operation, the bleeding sites were confirmed with one SMA, one right
colic artery, one internal carotid artery (ICA), and two bleeding jejunal arteries.
Inferior mesenteric vein with the ascending branch of left
colic artery was lying close to the mouth of the sac.
In our study, there was only one case of procedure-related bowel ischemia secondary to microcoil embolization of the right
colic artery. This elderly frail patient with multiple co-morbidities had been angioembolized in the past in the same vascular territory and a repeat angioembolization in the same area blocked all collateral vessels resulting in ischemia of the involved segment.
One case of necrotizing pancreatitis developed small pseudoaneurysm in close proximity to the previously embolized branch of the middle
colic artery. One patient with celiac artery pseudoaneurysm required second session of embolization followed by surgery due to intraprocedural complication.
The ascending and part of the transverse colon was used, basing the blood supply on the middle
colic artery. The transition to normal pharynx from the involved cervical oesophagus was difficult to ascertain since, despite mucosal healing, there was some degree of fibrosis at the site of the anastomosis.
There were no separate middle
colic artery arising from the superior mesenteric artery.
Following conventional angiography, active bleeding arteries were detected as right
colic artery (n=8), jejunal artery (n=6), ileocolic artery (n=4), superior rectal artery (n=4), middle
colic artery (n=3), sigmoidal artery (n=3), left
colic artery (n=2), ileal artery (n=2), ileal and ileocolic artery (n=1), and left colic and sigmoidal artery (n=1).
LPDH occurs when small intestine prolapses posteroinferiorly into this fossa (of Landzert), which is bounded by the fourth part of the duodenum, the posterior peritoneum, the inferior mesenteric vein, and left branches of the middle
colic artery [7, 8].
Typically, embolus lodges at the major branch distal to the middle
colic artery, preserving the blood supply of transverse colon and proximal jejunum.