Preoperative Highly Selective Catheter Localization of Occult Small-Intestinal Hemorrhage With Methylene Blue Dye

McDonald et al¹ reported the success of injecting methylene blue dye via a highly selective angiographic catheter in localizing occult small-intestinal hemorrhage intraoperatively. In 1980 Athanasoulis and colleagues² reported an ingenious intraoperative localization procedure for small-bowel bleeding by injecting methylene blue through a superselectively prepositioned coaxial angiographic catheter. Subsequently, we modified their technique by performing a superselective angiography using a single preshaped catheter and advancing the catheter as distally as possible in a single stage.³ In our series, methylene blue injection stained a median length of 30 cm of small intestine (range, 15 to 45 cm). Resection of this segment of stained bowel, as reported by McDonald et al, would remove the lesion. Accidental dislodgment of the tip of the angiographic catheter during transfer to the operating room and at operation is a possibility. This could lead to the staining of a segment of small bowel that