Post polypectomy colonic bleeding

Case contributed by Craig Hacking
Diagnosis not applicable

Presentation

Bright red PR bleeding 8 hours post colonoscopy and polypectomy. HR, BP, RR normal. Hb mildly decreased.

Patient Data

Age: 40 years
Gender: Female
This study is a stack
Axial
non-contrast
This study is a stack
Axial C+
arterial phase
This study is a stack
Coronal C+
arterial phase
This study is a stack
Sagittal C+
arterial phase
This study is a stack
Axial C+ portal
venous phase
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Info

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.

This study is a stack
Frontal Superior
mesenteric artery
This study is a stack
Frontal Superior
mesenteric artery
This study is a stack
Frontal
Ileocolic artery
This study is a stack
Frontal Post
embolisation
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Info

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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