Presentation
Rectal bleeding.
Patient Data
There is an active arterial contrast blush within the cecum and proximal ascending colon, just above the ileocecal valve. Scattered sigmoid colonic diverticula with no evidence of acute inflammation. Bowel is otherwise unremarkable, no evidence of obstruction. There is no free fluid or free gas. The liver, spleen, pancreas, and adrenal glands are unremarkable. Common biliary duct dilation (1.4 cm), no obstructive cause seen. Minor intrahepatic biliary dilatation. Gallbladder is unremarkable. Small cortical and para-pelvic renal cysts on the left; kidneys show normal enhancement and appearances, no hydronephrosis. No lymph node enlargement. No suspicious bone lesions are seen. Mild dependent atelectasis in both lungs bases.
Mesenteric angiogram & coil embolization of the Rt colic branch artery
Procedure performed under local anesthetic (1% lignocaine). Right common femoral artery puncture and retrograde 5-French sheath. The superior mesenteric artery was selected using a 5-French diagnostic Cobra (C2) catheter. Initial angiography confirmed bleeding in the proximal ascending colon. 10mg of Buscopan was given to reduce peristalsis of the bowel, and improve image quality. A Progreat microcatheter was used to select the right colic artery. An inferior branch arising from the right colic artery was a super selected and demonstrated to supply the area of active bleeding. The artery was then embolized using a series of 2 mm coils. Completion angiography confirmed occlusion of this vessel, and cessation of bleeding.
Case Discussion
This case illustrates a successfully managed case of lower gastrointestinal bleeding in an elderly patient who presented with active rectal bleeding in the Emergency Department, had the bleeding identified on CT and, then, was treated angiographically an hour later.
Special thanks to Dr Steve Bush and the angiography team.
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