Percutaneous angiographic arterial embolization of a vascular lesion in the colon of a patient on anticoagulant therapy

A 66-year-old woman had a history of acute pulmonary thromboembolism two months before admission for which she was on treatment with acenocoumarol.

She sought care for haematochezia for the past two days. Physical examination detected hypotension and tachycardia, with no other findings.

Laboratory testing revealed a haemoglobin (Hb) level of 7.5 g/dl and an international normalised ratio (INR) of 8. The patient was administered two units of packed red blood cells and an ampoule of vitamin K, as well as intensive fluid replacement therapy, thus restoring haemodynamic stability. A colonoscopy showed a submucosal pulsatile lesion in the caecum with angiomas on its surface (Fig. 1 and Appendix A [Video]). The study was extended with abdominal computed tomography (CT) angiography. This ruled out a neoformative lesion and showed a hypertrophic vessel with a submucosal trajectory in the anterior wall of the caecum (Fig. 2), which suggested that the lesion was of vascular aetiology.^1,2 Given the size thereof and the low suspicion of cancer, surgical resection was ruled out in favour of elective angiographic treatment with embolisation of the right colic artery branch from which the lesion originated; this treatment was successful (Fig. 3).³

Figure 1.

Endoscopic imaging of lesion.

Figure 2.

Abdominal and pelvic CT (oblique slice).

Figure 3.

Arteriography imaging after embolisation.

As a complication, the patient developed ischaemic ileocolitis confirmed on CT angiography which resolved with medical treatment. She was discharged on anticoagulant therapy, with radiological monitoring by means of CT. After a year of follow-up, she presented no relapses and showed decreased inflammatory changes.