Selective intra-arterial terlipressin infusion stops acute lower gastrointestinal bleeding: a case report and review of literature

Acute gastrointestinal bleedings are considered clinical emergency events and implicate a difficult medical decision-making process, in particular in poor surgical candidates. Here, we report one case with acute lower gastrointestinal bleeding, for the first time, treated with selective intra-arterial infusion of terlipressin (triglycyl lysine-vasopressin), a long-acting vasopressin analogue. The patient was affected by lung adenocarcinoma with abdominal metastasis and presented severe lower intestinal bleeding. Using selective angiography, the middle colic artery was catheterized and terlipressin was infused as follows: 1.5 mg in bolus (21 microg/kg), then 1.5 mg (21 microg/kg) intra-arterially in 20 min, then 1.5 mg in bolus (21 microg/kg), determining the cessation of the lower gastrointestinal bleeding. Since no cases of intra-arterial selective infusion of terlipressin have been reported in the literature, terlipressin may represent a new useful tool in pharmaco-angiographic strategy. The present case should prompt its consideration for further clinical studies.