Presentation
Bright red blood per rectum. Mild tachycardia. Low hemoglobin.
Patient Data
Arterial sigmoid colon diverticular hemorrhage with contrast dispersing and pooling on portal venous phase. Extensive sigmoid colon diverticulosis. No focal colonic wall thickening or pericolic fat stranding.
Normal appearance of the liver. Cholelithiasis in a collapsed gallbladder. No pericholecystic fluid. Normal appearance of the pancreas, spleen, and adrenal glands. Several fluid-density cortical renal cysts bilaterally.
Mural calcification along the abdominal aorta without aneurysmal dilatation. Minor calcification along the bilateral femoral arteries.
Small pericardial effusion.
Lytic lesion in the right sacrum is unchanged over the past 2 years. Osteopenia. Grade 1 anterolisthesis of L5 on S1. L2 heamangioma.
Impression
Arterial sigmoid colon diverticular hemorrhage. IR team notified.
Right CFA accessed under ultrasound fluoroscopic guidance and a 5-French sheath was inserted. IMA catheterized and angiography performed, demonstrating active arterial bleeding and a pseudoaneurysm arising from a sigmoid branch of the IMA. A microcatheter was advanced to the bleeding branch and embolization was performed with pushable coils. Satisfactory hemostasis at completion.
Case Discussion
The patient had an uneventful recovery. The sacral lytic lesion was from a malignancy in remission.
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