A Case of Intra–abdominal Hemorrhage Resulting from a Rectal Foreign Body in Which Hemostasis Was Achieved Through Selective Transcatheter Arterial Embolization

Abstract

A 30–year–old male patient was admitted to the emergency room of our hospital complaining of persistent abdominal pain of acute onset and weakness. Focused assessment with sonography for trauma (FAST) revealed ascites in the pericystic region and on the surface of the liver. Abdominal CT revealed massive intraabdominal hemorrhage with extravasation of contrast medium near the rectum, thinning of the anterior rectal wall, and parenteral gas in the perirectal region. An additional medical interview to determine a history of trauma revealed that the patient had inserted a plastic bottle into his anus six hours prior to the onset of the symptoms. He was diagnosed as having rectal arterial bleeding caused by transanal insertion of a rectal foreign body, and angiography was performed. Inferior mesenteric artery arteriography indicated extravasation of contrast medium from a branch of the superior rectal artery. Therefore, we performed selective transcatheter arterial embolization (TAE) of the vasa recta of the superior rectal artery, and succeeded in achieving hemostasis. The patient was able to eat on postoperative day 2 and was discharged, after an uneventful postoperative course, on postoperative day 8. Colonoscopy performed on postoperative day 7 showed a rectal ulcer that was thought to be due to ischemia. We report a rare case of intraabdominal hemorrhage caused by transanal insertion of a rectal foreign body, in which hemostasis was successfully achieved by selective TAE.