INTRODUCTION

Endovascular angiography (EA) and transcatheter arterial embolization (TAE) are diagnostic and therapeutic procedures indicated in the management of selected gastrointestinal bleedings, particularly in hemodynamically unstable patients or when endoscopy is ineffective or unable to localize the bleeding source. Although it is a minimally invasive and generally safe technique, it is not exempt from complications, including intestinal ischemia.

CASE REPORT

A 78-year-old man with a history of ischemic heart disease was admitted to the hospital due to episodes of hematochezia without initial analytical impact. An abdominal CT scan revealed only diverticulosis. During hospitalization, rectal bleeding recurred with hemodynamic instability and anemia, requiring transfusion of up to eight red blood cell units. Upper endoscopy showed no abnormalities, and colonoscopy revealed abundant fresh blood without an identifiable source. CT angiography demonstrated an arterial bleeding focus in the hepatic flexure. Arteriography with embolization of three arterial branches from the ascending branch of the right colic artery was performed, achieving a significant reduction in blood flow. After 48 hours, new bleeding and anemia occurred. Repeat colonoscopy identified a pale mucosa with a fibrin-covered ulcer located at the hepatic flexure, likely secondary to post-embolization ischemia. The patient improved with conservative management, achieving clinical and analytical stability, with no further bleeding episodes.

DISCUSSION

Transcatheter arterial embolization is an effective and minimally invasive therapy for lower gastrointestinal bleeding, especially when endoscopic management fails. Although modern super-selective techniques have reduced complications, intestinal ischemia remains the main risk. A decrease in local blood flow may lead to mucosal damage, manifesting as ulcers or, rarely, necrosis or perforation. The hepatic flexure is particularly vulnerable due to its watershed vascular supply, which explains the ischemic ulcer observed in this patient. Early endoscopic reassessment is essential when rebleeding occurs, allowing prompt diagnosis and conservative management in most cases. This case highlights the importance of clinical vigilance after embolization to ensure timely recognition of ischemic injury and prevent severe outcomes.