Presentation
Bright red PR bleeding 8 hours post colonoscopy and polypectomy. HR, BP, RR normal. Hb mildly decreased.
Patient Data
Active arterial bleeding within the ascending colon just superior to level of the ileocecal valve. No evidence of perforation. No free fluid. Remainder of the bowel is normal.
Normal appearance of the solid organs. Gallstones within the gallbladder.
Mirena IUD within the uterus.
Impression
Active arterial bleeding from the ascending colon (site of polypectomy according to the procedure notes). IR opinion recommended.
The patient became hypotensive and tachycardic after the CT. The patient was taken to the IR suite immediately.
SMA angiogram demonstrates brisk active bleeding from a small terminal branch of the ileocolic artery. Branch accessed with microcatheter and 2x embolization coils deployed. Complete cessation of bleeding achieved.
Case Discussion
Hemodynamic instability resolved following the IR embolization. The patient recovery uneventfully.
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