Late traumatic colonic bleeding

Clinical History

Acute bleeding from iliocolic artery into the ascending colon

Imaging Findings

Patient underwent a car accident three weeks earlier. Due to massive abdominal trauma laparotomy was performed. Patient was under intensive care for the last three weeks when he suddenly started to bleed from the anus. Colonoscopy was not able to prove sufficeintly the source of bleeding, gastroscopy was negative. In order to localize the source of bleeding, selcetive mesentericography was performed (Fig. 1a). A contrast deposition was found in the location of the ascending colon with a contrast spot staying present even on plain abdominal film (Fig 1b). This finding proved acute bleeding into the ascending colon from a branch of the ileocolic artery (Fig. 1c).

Discussion

Bleeding from a branch of the superior mesenteric artery is normally found only if massive bleeding is present. In case of a vascular dysplasia, an early filling of veins is normally found which is not present in that case. Cause for bleeding is not abvious from angiography but during immediate surgery a posttraumatic old rupture of the ascending colon was found that led to acute bleeding. Why this started just three weeks after primary trauma remains unknown. Transvascular embolization would have been only indicated in case, immediate surgery would not have been possible in order to interrupt the acute bleeding. Otherwise embolization is contraindicated because of induction of late colonic stenosis

Differential Diagnosis List

Final Diagnosis

Postraumatic bleeding from colonic rupture

URL:	https://www.eurorad.org/case/479
DOI:	10.1594/EURORAD/CASE.479
ISSN:	1563-4086