Presentation
PR bleeding? localization.
Patient Data
Multiple diverticuli with a contrast blush in the midpoint of the sigmoid colon that increases on the portal venous images in keeping with active extravasation of contrast. Previous right hemicolectomy and cholecystectomy. There is adjacent mild pericolic stranding.
There is a 15mm hypodensity (18 HU) in segment V of the liver that does not demonstrate enhancement and was not present on previous imaging. It likely represents a simple cyst and this could be confirmed on ultrasound.The spleen, pancreas are unremarkable. Bilateral simple renal cysts. Bulky appearance of the left adrenal gland is unchanged from 2009. Moderate prostatomegaly (64 x 57 x 58 mm) with nodular indentation of the bladder. No free intraperitoneal gas or fluid.
Conclusion:
Active extravasation of contrast within the sigmoid colon in keeping with active bleeding from a middle sigmoid branch of the inferior mesenteric artery.
IMA angiography with superselective runs identified the bleeding point, corresponding to CTA. Superselective microcoil embolization as close to the bleeding point was performed using 5mm fibred microcoils with angiographic resolution of the bleeding.
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