Localized sigmoid perforation post embolization for bleeding diverticulum

Case contributed by Chris O'Donnell
Diagnosis almost certain

Presentation

Severe abdominal pain and fever. History of catheter embolization for sigmoid diverticular hemorrhage 2 days before.

Patient Data

Age: 85 years
Gender: Female

Contrast extravasation from a diverticulum in the sigmoid indicating active bleeding (arrow). Surgeons opted for embolization as treatment rather than surgery.

Coils in branches of the IMA associated with gas in the sigmoid colon wall and adjacent soft tissues indicative of localized bowel wall ischemia and perforation. 

Case Discussion

Selective catheter embolization with micro coils/glue/microparticles is the treatment of choice for bleeding colonic diverticula especially in the elderly with high operative risk. Embolization complications including bowel wall ischemia are uncommon especially if superselective occlusion of marginal branches is performed.

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