Localized sigmoid perforation post embolization for bleeding diverticulum
Had catheter embolisation for sigmoid diverticular haemorrhage 2days previously. Now severe abdominal pain and fever
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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. 2 days previously there was contrast extravasation from a diverticulum in the sigmoid indicating active bleeding (arrow). Surgeons opted for embolization as treatment rather than surgery.
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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