Effective Management of Ileocecal Hemorrhage with Super-Selective Arterial Embolization: A Case Study

Abstract

Background: Acute colonic bleeding, including rectal bleeding and melena, affects approximately 36 per 100,000 people annually, with a higher incidence in the elderly. Effective management requires prompt diagnosis and intervention, especially for severe cases characterized by persistent bleeding and significant decreases in hemoglobin levels. Traditional therapeutic options include pharmacologic therapy, endoscopic coagulation, transcatheter therapy, and surgery. While percutaneous embolization is established for upper GI bleeding, its effectiveness for lower GI bleeding remains debated due to concerns over potential intestinal infarction. Methods: We present a case of a 31-year-old female with a history of severe mitral regurgitation and chronic atrial fibrillation who underwent mitral valve replacement. Post-operatively, she developed black tarry stools indicative of lower GI bleeding. Initial treatments, including proton pump inhibitors, tranexamic acid, and vitamin K, were ineffective. Gastroscopy and colonoscopy showed no active bleeding, but abdominal CT revealed contrast extravasation at the ileocecal junction, likely from the ileocolic artery. Super-selective arterial embolization was performed using a 6 Fr femoral sheath and microcatheter (2.7 Fr) with non-spherical polyvinyl alcohol (nsPVA) particles (355-500 μm) to target the bleeding source. Results: The embolization successfully halted hematochezia with no signs of peritonitis or mesenteric infarction. Post-procedure, the patient was discharged after 4 days with no abdominal pain or readmission for complications. Conclusion: Super-selective arterial embolization is a safe and effective method for managing lower GI bleeding, with no observed intestinal infarction in this case. This approach demonstrates the feasibility of embolization in controlling severe colonic hemorrhage, potentially offering a viable alternative to more invasive procedures while minimizing the risk of bowel ischemia.