Fig. 1. A 76-year-old patient with multiple recurrent episodes of massive bright-red lower gastrointestinal (GI) bleeding, with two prior negative conventional arteriograms. One of two previous tagged red blood cell scans were positive for active bleeding in the region of the hepatic flexure. (A) Initial superior mesenteric artery (SMA) arteriogram is negative for active extravasation. (B) After administration of 5,000 units of intravenous heparin as well as intra-arterial injection of 200 μg of nitroglycerin and 8 mg of tissue plasminogen activator into the SMA, there is active extravasation at the hepatic flexure (arrow). (C) After superselective coil embolization (arrow), there is no further extravasation. The patient had no subsequent episodes of GI bleeding.
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