Urgent Embolization of Bilateral Middle Rectal Artery in the Management of Life-Threatening Hemorrhoid Bleeding in a Patient with Occlusion of the Inferior Mesenteric Artery

Background: Internal hemorrhoids rarely cause life-threating massive rectal bleeding and usually depend on the inflow of the superior rectal arteries. We report a case of an urgent emborrhoid technique by embolizing both middle rectal arteries in a patient presenting with a life-threatening rectal bleeding and an occluded inferior mesenteric artery on CT scan. Method(s): The procedure was performed with a right femoral arterial approach. Left internal iliac artery was cannulated with a 5 F long sheath (after cross- over). Angiographies then Cone Beam CT (CBCT) were performed showing a large anastomotic left middle rectal artery involved in the hemorrhoidal vascularazition. Superselective catheterization of left middle rectal artery was realized using a 2.8 F microcatheter. Then embolization using a packing of microcoils and some pledget of gelfoam to close the anastomotic shunts was performed. Right internal iliac artery was then catheterized. Angiography and CBCT showed a less anastomotic right middle rectal artery involvement in hemorrhoid vascularization but confirmed the origin of the bleeding with contrast within the rectum. Hence, only one microcoil was used and some gelfoam pledget. Result(s): Angiographies and CBCT confirmed the origin of the bleeding and showed satisfying final result with complete exclusion of internal hemorrhoids. Stabilization of vital signs was perceived during the procedure. A three weeks clinical and endoscopic follow-up showed no recurrence of the bleeding. Conclusion(s): Emborrhoid technique can be used in urgent treatment of massive hemorrhoid bleeding even when the access to the inferior mesenteric artery is not possible by embolizing middle rectal artery as it is the main blood supply of hemorrhoid in this case. CBCT helps identifying the main feeder arteries and guides the embolization.

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Artikel online veröffentlicht:
11. Mai 2021