Endovascular management of severe lower gastrointestinal bleeding from angiodysplasia in the cecum: A case report

Abstract

Gastrointestinal angiodysplasias (GIADs) are rare disorder but can cause noticeable issue clinically. Their clinical characteristics can range from being an asymptomatic incidental finding to causing life-threatening bleeding. Many modalities are applied for treating bleeding GIADs include endoscopic therapies, angiography with embolization, surgical resection, and pharmacologic therapy. However, since patients with GIADs are often aged and have many comorbidities, endoscopic therapies may not be the best initial option. Angiography is suitable method for hemodynamically unstable patients with active bleeding, patients with an unknown active bleeding source, and patients who are poor surgical candidates. Angiography not only diagnose the bleeding point but also provide therapeutic endovascular intervention at the same time. We report a case of endovascular management of severe lower gastrointestinal bleeding from a GIAD in the cecum using a mixture of n-butyl cyanoacrylate and lipiodol to embolize the bleeding source. Clinical symptoms improved without prominent complications.

Keywords: Angiodysplasia; Lower gastrointestinal bleeding; Selective transarterial embolization.

Fig. 1

MSCT axial images in the arterial (A) and venous (B) phase show a hyperattenuated spot in the cecum (arrow) that faded into an enlarged, enhanced collection in the delay phase (C), a sign of active extravasation.

Fig. 2

(A) Digital subtraction angiography of the ileocecal artery confirms a GIAD (arrow). (B) Angiography shows complete embolization of the lesion after superselective embolization.

Fig. 3

An MSCT coronal image in arterial (A) and axial images in venous (B) and delay (C) phases 3 days after the embolization procedure showed a mixture of NBCA and lipiodol at the GIAD site (arrow). There was no sign of extravasation or bowel infraction.