An 85-year-old woman presented with intermittent abdominal pain and bloody stool. Contrast-enhanced computed tomography (CT) revealed a 55-mm pelvic mass with contrast extravasation adjacent to the rectum (Picture 1A). Colonoscopy revealed a large, half-circumferential subepithelial lesion with active bleeding (Picture 1B, C). Although temporary hemostasis was achieved (Picture 1D), transcatheter arterial embolization was performed because of concerns about rebleeding. Angiography confirmed the rupture of a superior rectal artery aneurysm, which was successfully embolized (Picture 2A, B). Follow-up endoscopy revealed lesion shrinkage, cavity formation at the ulcer site, and no signs of malignancy (Picture 3A: day 8; Picture 3B: day 15). Subsequent follow-up demonstrated endoscopic scarring and hematoma resolution on CT. Rupture of a superior rectal artery aneurysm is rare, with trauma and neurofibromatosis type 1 being the most common causes (1,2). This case highlights the need to consider the vascular causes of atypical lower gastrointestinal bleeding.
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The authors state that they have no Conflict of Interest (COI).
References
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